Healthcare Provider Details

I. General information

NPI: 1063446672
Provider Name (Legal Business Name): MATTHEW JOSEPH ECKERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 FITZSIMMONS DR DEPT SURGERY, MADIGAN ARMY MEDICAL CENTER
JOINT BASE LEWIS MCCHORD WA
98431-1000
US

IV. Provider business mailing address

2916 N PUGET SOUND AVE
TACOMA WA
98407-5932
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2200
  • Fax:
Mailing address:
  • Phone: 312-342-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23646
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD60272442
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: