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General NPI Number Information
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NPI Number | 1053525014
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Entity Type | Individual
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Provider Name | RICHARD E. ECCLES M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 219 STATE AVE N STE 100
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City | KENT
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State | WA
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Zip | 98030-4543
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Country | US
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Telephone | 253-372-3602
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Fax | 253-852-4879
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4692
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Country | US
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Telephone | 615-372-6548
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-7083
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD61637642
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61637642
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q9338
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-7083
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License Number State | AR
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