MEDICARE: DR. JON L ECK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G67867	CA

General Provider Information

NPI Number	:	1649256934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON L ECK MD

Provider Business Mailing Address
First Line	:	4310 SAINT ANDREWS DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-1846
Country	:	US
Telephone Number	:	209-952-1722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 ARCH RD STE 400
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95215-8315
Country	:	US
Telephone Number	:	209-943-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	09/14/2009

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