Provider Demographics
NPI:1184681108
Name:ECKRICH, PAUL C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:ECKRICH
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-225-7326
Mailing Address - Fax:605-229-2774
Practice Address - Street 1:201 S LLOYD ST
Practice Address - Street 2:SUITE E105
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4552
Practice Address - Country:US
Practice Address - Phone:605-225-7326
Practice Address - Fax:605-229-2774
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3515208800000X
ND6821208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006854OtherWELLMARK BCBS OF SD
SD7500243Medicaid
ND17721Medicaid
MN779513100Medicaid
SD3515OtherDAKOTACARE
ND13029Medicaid
SDS102901Medicare PIN
SDP00627348Medicare PIN
ND17721Medicaid
SDE74053Medicare UPIN
SD340018040Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MN779513100Medicaid