Provider Demographics
NPI:1831225549
Name:ECKLUND, NATHAN B (DPM)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:B
Last Name:ECKLUND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S HALCYON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3863
Mailing Address - Country:US
Mailing Address - Phone:805-481-0881
Mailing Address - Fax:805-481-0835
Practice Address - Street 1:310 S HALCYON RD STE 101
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3863
Practice Address - Country:US
Practice Address - Phone:805-481-0881
Practice Address - Fax:805-481-0835
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4678213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4678OtherBLUE CROSS
CA000E46780Medicaid
CA00E46780OtherBLUE SHIELD
CA000E46780Medicaid
CA00E46780OtherBLUE SHIELD