Basic Information
Provider Information
NPI: 1336180751
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ECKARD
FirstName: VALERIE
MiddleName: ROCKWELL
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MOLLOY
OtherFirstName: VALERIE
OtherMiddleName: ROCKWELL
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 5
Mailing Information
Address1: 11995 SINGLETREE LN
Address2: SUITE 500
City: EDEN PRAIRIE
State: MN
PostalCode: 553445347
CountryCode: US
TelephoneNumber: 9525951301
FaxNumber: 6122944903
Practice Location
Address1: 1325 PACIFIC HWY
Address2: #3204
City: SAN DIEGO
State: CA
PostalCode: 921012580
CountryCode: US
TelephoneNumber: 9525951100
FaxNumber: 6122944903
Other Information
ProviderEnumerationDate: 06/09/2006
LastUpdateDate: 07/20/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X2000153498MON Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XC52585CAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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