Provider Demographics
NPI:1033555230
Name:ECKER, SAMUEL BLAKE (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BLAKE
Last Name:ECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2710 WESTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6503
Mailing Address - Country:US
Mailing Address - Phone:970-682-3377
Mailing Address - Fax:970-682-3340
Practice Address - Street 1:204 MCCOLLUM ST STE 106E
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5151
Practice Address - Country:US
Practice Address - Phone:970-682-3377
Practice Address - Fax:970-682-3340
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6858A207N00000X
CO0061328207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology