Provider Demographics
NPI:1720163405
Name:ECKERT, JOSEPH C (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:ECKERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 DUNN RD
Mailing Address - Street 2:STE 204
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033
Mailing Address - Country:US
Mailing Address - Phone:314-831-2600
Mailing Address - Fax:314-831-5393
Practice Address - Street 1:3533 DUNN RD
Practice Address - Street 2:STE 204
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-831-2600
Practice Address - Fax:314-831-5393
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41718Medicare UPIN
MO000009016Medicare ID - Type Unspecified