Provider Demographics
NPI:1003817743
Name:ECKMAN, CHARLES ERIC (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ERIC
Last Name:ECKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 N WESTERN AVE #422
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:
Practice Address - Street 1:14101 PARKWAY COMMONS
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6012
Practice Address - Country:US
Practice Address - Phone:405-749-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK123322085R0202X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100259370AMedicaid
OKE28945Medicare UPIN
OK100259370AMedicaid