Healthcare Provider Details

I. General information

NPI: 1407849623
Provider Name (Legal Business Name): C. ERIC ECKMAN, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 PARKWAY COMMONS DR
OKLAHOMA CITY OK
73134-6012
US

IV. Provider business mailing address

2224 NW 50TH ST SUITE 276W
OKLAHOMA CITY OK
73112-8046
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-2762
  • Fax:
Mailing address:
  • Phone: 405-858-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ERIC ECKMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 405-858-2350