Provider Demographics
NPI:1821000704
Name:ECKSTEIN, LARRY (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:ECKSTEIN
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 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:2760 29TH ST
Practice Address - Street 2:SUITE 2-D
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1214
Practice Address - Country:US
Practice Address - Phone:303-546-9158
Practice Address - Fax:303-546-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33042208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01330422Medicaid
CO01330422Medicaid