Provider Demographics
NPI:1184642522
Name:ECKHARDT, KARL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ROBERT
Last Name:ECKHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OCONNER LN
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3678
Mailing Address - Country:US
Mailing Address - Phone:509-522-0479
Mailing Address - Fax:509-522-0512
Practice Address - Street 1:8 OCONNER LN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3678
Practice Address - Country:US
Practice Address - Phone:509-522-0479
Practice Address - Fax:509-522-0512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029573207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA35204Medicare UPIN