Provider Demographics
NPI:1154417442
Name:ECKHARDT, DONALD KENT (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:KENT
Last Name:ECKHARDT
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 1:455 SCHOOL ST
Mailing Address - Street 2:SUITE 29
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4595
Mailing Address - Country:US
Mailing Address - Phone:281-374-1860
Mailing Address - Fax:281-255-0550
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:SUITE 29
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4595
Practice Address - Country:US
Practice Address - Phone:281-374-1860
Practice Address - Fax:281-255-0550
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1981207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123372802Medicaid
TX88V282Medicare PIN
TX123372802Medicaid
TXTXB148595Medicare PIN
GA16003428Medicare PIN