Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00032475 | WA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD00032475 | WA |
NPI | 1154432904 |
---|---|
Provider Name | Mr. Kirk Torgle Ecklund |
First Address | Yakima, WA 98902-7807 |
Second Address | Yakima, WA 98902-7807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B178956 | (05) | WA |
G12755 | (02) |