Organization
JERROLD ECKLIND DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERROLD RANDALL ECKLINDS D.O. (PRESIDENT)
(386) 615-8300
Entity
Organization
Contact information
Practice address
555 W GRANADA BLVD, SUITE D-2, ORMOND BEACH, FL 32174-9485
(386) 615-8300
(386) 677-1818
Mailing address
555 W GRANADA BLVD, SUITE D-2, ORMOND BEACH, FL 32174-9485
(386) 615-8300
(386) 677-1818
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
OS7663
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851390322
NPI
FL
01
—
49221
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/05/2008
Last updated
06/27/2008
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