Provider Demographics
NPI:1932340494
Name:LARRY ECKSTEIN, M.D., P.C.
Entity Type:Organization
Organization Name:LARRY ECKSTEIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-917-2612
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33042208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01330422Medicaid
CO33042OtherMEDICAL LICENSE NUMBER
COA44118OtherUPIN #
CO33042OtherMEDICAL LICENSE NUMBER
CO1821000704OtherINDIVIDUAL NPI #