MEDICARE: DR. JERROLD RANDALL ECKLIND D.O.

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	OS7663	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JM261	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851390322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERROLD RANDALL ECKLIND D.O.

Provider Business Mailing Address
First Line	:	300 S MAIN ST STE 2
Second Line	:
City	:	WILDWOOD
State	:	FL
Zip	:	34785-4542
Country	:	US
Telephone Number	:	352-643-6699
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S MAIN ST STE 2
Second Line	:
City	:	WILDWOOD
State	:	FL
Zip	:	34785-4542
Country	:	US
Telephone Number	:	352-643-6699
Fax Number	:	888-675-8377

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	10/28/2021

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