Individual
ALLENSCOTT W EACKER
Active
Individual
ALLENSCOTT W EACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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
Update your record
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