Provider Demographics
NPI:1700081742
Name:RICHARD I. ECKER
Entity Type:Organization
Organization Name:RICHARD I. ECKER
Other - Org Name:YAMHILL VALLEY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:ECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-472-1405
Mailing Address - Street 1:706 NE EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3926
Mailing Address - Country:US
Mailing Address - Phone:503-472-1405
Mailing Address - Fax:503-434-5950
Practice Address - Street 1:706 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3926
Practice Address - Country:US
Practice Address - Phone:503-472-1405
Practice Address - Fax:503-434-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11786207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR168823OtherOMAP
ORR0000BHKMSOtherMEDICARE ID
OR287583OtherOMAP
OR5512000OtherBLUE CROSS OF OREGON
ORC92560Medicare UPIN