Healthcare Provider Details

I. General information

NPI: 1881697787
Provider Name (Legal Business Name): RICHARD I ECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 NE EVANS ST
MCMINNVILLE OR
97128-3926
US

IV. Provider business mailing address

706 NE EVANS ST
MCMINNVILLE OR
97128-3926
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-1405
  • Fax: 503-434-5950
Mailing address:
  • Phone: 503-472-1405
  • Fax: 503-434-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD11786
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD11786
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD11786
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD11786
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: