Healthcare Provider Details

I. General information

NPI: 1659712503
Provider Name (Legal Business Name): BRANDON T ECCLES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N PIEDRAS ST
EL PASO TX
79930-5097
US

IV. Provider business mailing address

1157 REGAL RIDGE DR
EL PASO TX
79912-7438
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-2650
  • Fax:
Mailing address:
  • Phone: 719-250-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0055185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: