Jerrold Ecklind DO PA

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

OS7663 Issued in FL

Legal business name

JERROLD ECKLIND DO PA

Practice address

555 W Granada Blvd
Suite D-2
Ormond Beach, FL 32174-9485

Phone

(386) 615-8300

Fax

(386) 677-1818

NPI assigned

Jun 5, 2008

Last updated

Jun 27, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerrold Randall Ecklinds, D.O.

Title

President

Phone

(386) 615-8300

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerrold Randall Ecklind, D.O.

  • Family Medicine Physician
  • Wildwood, FL
  • NPI 1851390322
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1548429590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W GRANADA BLVD",
            "address_2": "SUITE D-2",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321749485",
            "telephone_number": "386-615-8300",
            "fax_number": "386-677-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W GRANADA BLVD",
            "address_2": "SUITE D-2",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321749485",
            "telephone_number": "386-615-8300",
            "fax_number": "386-677-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERROLD ECKLIND DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "ECKLINDS",
        "authorized_official_first_name": "JERROLD",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-615-8300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "OS7663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851390322",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "49221",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jean-Claude Jeanty, M.D.
• Demeshanique Jefferson
• Jeffrey Demercurio MD PA (Florida Center for Plastic and Cosmetic Surgery)
• Jeffrey T Newfield DO PA (Newfield Orthopedics)
• Kimberly Deanne Jensen, LCSW
• John B Turner MD PA
• John F Cullen MD
• John R. Chewning DO PA
• John Zak III PA Inc
• Chhaya Johnson, MA

• Medical Specialty Clinic/Center in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.