Healthcare Provider Details

I. General information

NPI: 1306893359
Provider Name (Legal Business Name): ERIC M KRASKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 E COPPER POINT DR
MERIDIAN ID
83642-9055
US

IV. Provider business mailing address

PO BOX 2505
SALEM OR
97308-2505
US

V. Phone/Fax

Practice location:
  • Phone: 208-947-0590
  • Fax:
Mailing address:
  • Phone: 888-828-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2004-0116
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD175591
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: