Provider Demographics
NPI:1770571200
Name:EDDY, RICHARD L (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:EDDY
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 1:221 W STEWART AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3609
Mailing Address - Country:US
Mailing Address - Phone:541-776-2003
Mailing Address - Fax:541-776-9833
Practice Address - Street 1:221 W STEWART AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3609
Practice Address - Country:US
Practice Address - Phone:541-776-2003
Practice Address - Fax:541-776-9833
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21518207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151289Medicaid
ORH680401OtherPACIFIC SOURCE
OR151289Medicaid
A87981Medicare UPIN