MEDICARE: RICHARD I. ECKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	MD11786	OR
2	207ND0900X	Dermatopathology Physician	MD11786	OR
3	207NS0135X	Procedural Dermatology Physician	MD11786	OR
4	207N00000X	Dermatology Physician	MD11786	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R0000BHKMS	OTHER	OR	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	168823	OTHER	OR	OMAP
3	287583	OTHER	OR	OMAP
4	5512000	OTHER	OR	BLUE CROSS OF OREGON

General Provider Information

NPI Number	:	1700081742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD I. ECKER

Provider Business Mailing Address
First Line	:	706 NE EVANS ST
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-3926
Country	:	US
Telephone Number	:	503-472-1405
Fax Number	:	503-434-5950

Provider Business Practice Location Address
First Line	:	706 NE EVANS ST
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-3926
Country	:	US
Telephone Number	:	503-472-1405
Fax Number	:	503-434-5950

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD IVAN ECKER
Credential	:	M.D.
Telephone Number	:	503-472-1405

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/21/2012

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Directions to “RICHARD I. ECKER ” Practice Location

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