Provider Demographics
NPI:1538130612
Name:JECK, DAVID TODD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:JECK
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 1:677 N WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2701
Mailing Address - Country:US
Mailing Address - Phone:520-795-2889
Mailing Address - Fax:520-795-6321
Practice Address - Street 1:677 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2701
Practice Address - Country:US
Practice Address - Phone:520-795-2889
Practice Address - Fax:520-795-6321
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ287482085R0202X, 2085N0700X, 2085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1538130612OtherPHYSICIAN INDIVIDUAL NPI
AZ300130443OtherMEDICARE RAILROAD
AZ005472OtherGROUP MEDICAID ID
AZ689755Medicaid
AZZWCBBMOtherGROUP MEDICARE ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZ1841261989OtherGROUP NPI
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZ689755Medicaid