Healthcare Provider Details

I. General information

NPI: 1477549293
Provider Name (Legal Business Name): JAMES B. ECKMAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY SUITE 115
LOUISVILLE KY
40207-4652
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-8163
  • Fax: 502-897-8052
Mailing address:
  • Phone: 502-253-1035
  • Fax: 502-253-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01037798
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number24674
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: