Provider Demographics
NPI:1699768754
Name:ECKMAN, WALTER W (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:W
Last Name:ECKMAN
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:PO BOX 3660
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3660
Mailing Address - Country:US
Mailing Address - Phone:662-841-7585
Mailing Address - Fax:662-841-2667
Practice Address - Street 1:408 COUNCIL CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4949
Practice Address - Country:US
Practice Address - Phone:662-841-7585
Practice Address - Fax:662-841-2667
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSA03874Medicare UPIN