Provider Demographics
NPI:1659304459
Name:ECCLES, RALPH PARKER (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:PARKER
Last Name:ECCLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6066
Mailing Address - Country:US
Mailing Address - Phone:541-891-1899
Mailing Address - Fax:541-887-8170
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6066
Practice Address - Country:US
Practice Address - Phone:541-891-1899
Practice Address - Fax:541-887-8170
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO24643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00131465OtherMCR RAILROAD
OR227293Medicaid
ORD24778OtherCHAMPUS
CAXTE006916OtherCA WEL
CAXTE006916OtherCA WEL
ORD24778OtherCHAMPUS