Provider Demographics
NPI:1154432904
Name:ECKLUND, KIRK TORGLE (MD)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:TORGLE
Last Name:ECKLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3911 CASTLEVALE RD
Mailing Address - Street 2:STE 301
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7807
Mailing Address - Country:US
Mailing Address - Phone:509-966-7899
Mailing Address - Fax:509-225-6811
Practice Address - Street 1:3911 CASTLEVALE RD
Practice Address - Street 2:STE 301
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-965-1714
Practice Address - Fax:509-965-1714
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00032475207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB178956Medicaid
G12755Medicare UPIN
WAAB24839Medicare ID - Type Unspecified