Provider Demographics
NPI:1982809240
Name:ECK, JASON C (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:ECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4140 FERNCREEK DR STE 801
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2572
Mailing Address - Country:US
Mailing Address - Phone:910-484-2171
Mailing Address - Fax:910-484-4568
Practice Address - Street 1:4140 FERNCREEK DR STE 801
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2572
Practice Address - Country:US
Practice Address - Phone:910-484-2171
Practice Address - Fax:910-484-4568
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA236738207X00000X
NC2019-02773207X00000X, 207XS0117X
TN2433207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2156075Medicaid
TN455621522OtherTIN