Healthcare Provider Details

I. General information

NPI: 1902890643
Provider Name (Legal Business Name): JOHN D ECKRICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 WATSON RD
SAINT LOUIS MO
63119-4405
US

IV. Provider business mailing address

7345 WATSON RD
SAINT LOUIS MO
63119-4405
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-7100
  • Fax: 314-752-3284
Mailing address:
  • Phone: 314-752-7100
  • Fax: 314-752-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR6244
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: