Provider Demographics
NPI:1831327063
Name:ADAMS ECKMAN, TRISHA K (MD)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:K
Last Name:ADAMS ECKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:541-523-1152
Practice Address - Street 1:3950 17TH ST SUITE A
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-523-1001
Practice Address - Fax:541-523-1152
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49139207Q00000X
ORMD157590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR166822Medicare PIN