Healthcare Provider Details

I. General information

NPI: 1124331863
Provider Name (Legal Business Name): DUSTIN L ECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MCLEOD HEALTH BLVD BUILDING 3, SUITE 201
MYRTLE BEACH SC
29579-4477
US

IV. Provider business mailing address

115 MCLEOD HEALTH BLVD BUILDING 3, SUITE 201
MYRTLE BEACH SC
29579-4477
US

V. Phone/Fax

Practice location:
  • Phone: 843-646-8430
  • Fax: 843-646-8763
Mailing address:
  • Phone: 843-646-8430
  • Fax: 843-646-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN15231
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number82089
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: