Provider Demographics
NPI:1124331863
Name:ECK, DUSTIN L (MD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:L
Last Name:ECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MCLEOD HEALTH BLVD
Mailing Address - Street 2:BUILDING 3, SUITE 201
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4477
Mailing Address - Country:US
Mailing Address - Phone:843-646-8430
Mailing Address - Fax:843-646-8763
Practice Address - Street 1:115 MCLEOD HEALTH BLVD
Practice Address - Street 2:BUILDING 3, SUITE 201
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4477
Practice Address - Country:US
Practice Address - Phone:843-646-8430
Practice Address - Fax:843-646-8763
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC820892086S0122X
FLTRN15231390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program