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General NPI Number Information
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NPI Number | 1033555230
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Entity Type | Individual
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Provider Name | SAMUEL BLAKE ECKER D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 204 MCCOLLUM ST STE 106E
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City | LARAMIE
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State | WY
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Zip | 82070-5151
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Country | US
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Telephone | 970-682-3377
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Fax | 970-682-3340
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Provider Business Mailing Address
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Address Line | 2710 WESTRIDGE CT
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City | FORT COLLINS
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State | CO
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Zip | 80526-6503
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Country | US
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Telephone | 970-682-3377
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Fax | 970-682-3340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 6858A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0061328
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License Number State | CO
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