Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1513 | SD |
N | 207QA0505X | Family Doctor - Adult Medicine | 1513 | SD |
NPI | 1306892633 |
---|---|
Provider Name | Scott W Ecklund |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57110-5745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A02762 | (02) |