Healthcare Provider Details

I. General information

NPI: 1902832033
Provider Name (Legal Business Name): ALLENSCOTT W EACKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EXECUTIVE DR SUITE 104
NAPLES FL
34119-8805
US

IV. Provider business mailing address

4550 EXECUTIVE DR SUITE 104
NAPLES FL
34119-8805
US

V. Phone/Fax

Practice location:
  • Phone: 716-830-6224
  • Fax: 239-566-2519
Mailing address:
  • Phone: 716-830-6224
  • Fax: 239-566-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0033391
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: