Provider Demographics
NPI:1457470312
Name:ECKMANN, MAXIM SAVILLION (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:SAVILLION
Last Name:ECKMANN
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 1:5282 MEDICAL DR STE 614
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6115
Mailing Address - Country:US
Mailing Address - Phone:210-450-9850
Mailing Address - Fax:210-450-6095
Practice Address - Street 1:5282 MEDICAL DR STE 614
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6115
Practice Address - Country:US
Practice Address - Phone:210-450-9850
Practice Address - Fax:210-450-9095
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7159207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199762904OtherCSHCN
TX199762903Medicaid