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General NPI Number Information
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NPI Number | 1801248059
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Entity Type | Individual
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Provider Name | BRAD L ECKLOR PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 208 PARKER ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1648
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Country | US
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Telephone | 608-375-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 100 VIKING ST
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City | COON VALLEY
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State | WI
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Zip | 54623-8338
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Country | US
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Telephone | 608-498-0448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3796-23
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License Number State |
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