| Organization Name: | TERRY M. ECCLES, MD, LLC |
| NPI Number: | 1952689945 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERRY M. ECCLES (OWNER/PHYSICIAN) |
| Mailing Address: | 72-ll West Stafford Road Stafford Springs |
| State: | CT US |
| Postal Code: | 06076 |
| Phone Number: | 8606845015 |
| Fax Number: | 8606843749 |
| NPI Enumeration Date: | 07/26/2011 |
| NPI Last Update Date: | 11/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 005863 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |