Provider Demographics
NPI:1215434527
Name:ECK, JENNIFER LAUREN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAUREN
Last Name:ECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LAUREN
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 W BANDERA RD STE 9
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2521
Mailing Address - Country:US
Mailing Address - Phone:830-816-1717
Mailing Address - Fax:830-816-2103
Practice Address - Street 1:430 W BANDERA RD STE 9
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2521
Practice Address - Country:US
Practice Address - Phone:830-816-1717
Practice Address - Fax:830-816-2103
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1Q5002Medicaid
FE0344868OtherDEA