Provider Demographics
NPI:1083602569
Name:ECKERT, EDWARD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:DAVID
Last Name:ECKERT
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 1:2345 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1110
Mailing Address - Country:US
Mailing Address - Phone:954-427-4966
Mailing Address - Fax:954-427-6517
Practice Address - Street 1:2345 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1110
Practice Address - Country:US
Practice Address - Phone:954-427-4966
Practice Address - Fax:954-427-6517
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D29373Medicare UPIN
FL21912Medicare ID - Type Unspecified