Individual
ALLENSCOTT W EACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4550 EXECUTIVE DR, SUITE 104, NAPLES, FL 34119-8805
(716) 830-6224
(239) 566-2519
Mailing address
4550 EXECUTIVE DR, SUITE 104, NAPLES, FL 34119-8805
(716) 830-6224
(239) 566-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0033391
NY
363AM0700X
Medical Physician Assistant
Primary
PA9104665
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011220501
UNIVERA
NY
01
—
000570552002
BLUE CROSS BLUE SHIELD
NY
01
—
161480107
FIDELIS
NY
01
—
970018313
RAILROAD MEDICARE
NY
Enumeration date
06/23/2006
Last updated
07/22/2013
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