Provider Demographics
NPI:1326044975
Name:ECK, BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ECK
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 1:808 HICKORY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5184
Mailing Address - Country:US
Mailing Address - Phone:417-256-3782
Mailing Address - Fax:
Practice Address - Street 1:805 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775
Practice Address - Country:US
Practice Address - Phone:417-255-2301
Practice Address - Fax:417-255-2062
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112742208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00222120OtherRETIRED RAILROAD MEDICARE
MO208885111Medicaid
MO000095250Medicare ID - Type UnspecifiedBRYAN ECK, MD
MOG58513Medicare UPIN