Healthcare Provider Details

I. General information

NPI: 1063150662
Provider Name (Legal Business Name): LOGAN ECKHARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NORTH LOOP ROAD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

390 NORTH LOOP ROAD WOMEN'S HEALTH CLINIC
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5289
  • Fax:
Mailing address:
  • Phone: 760-383-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101279931
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: