Provider Demographics
NPI:1366417644
Name:ECHOLS, EDDY L JR (MD)
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:L
Last Name:ECHOLS
Suffix:JR
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 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-972-5055
Practice Address - Street 1:305 E BRANDON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5222
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6148
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89159207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268559100Medicaid
FL7521799OtherAETNA
FL8781424OtherCIGNA
FLP00341196OtherRAILROAD MEDICARE
FL291630OtherAVMED
FL37337OtherBC/BS
FL37337OtherBC/BS
FL7521799OtherAETNA