Provider Demographics
NPI:1306893359
Name:KRASKA, ERIC M (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:KRASKA
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:PO BOX 2505
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-2505
Mailing Address - Country:US
Mailing Address - Phone:888-828-3197
Mailing Address - Fax:
Practice Address - Street 1:2963 E COPPER POINT DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9055
Practice Address - Country:US
Practice Address - Phone:208-947-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004-0116207P00000X
ORMD175591207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10013393OtherLOVELACE
NM62157256Medicaid
85-0236178-031OtherMOLINA HEALTHCARE SALUD
85-0236178-021OtherMOLINA HEALTHCARE
14924OtherPRESBY- TERIAN
P00189012Medicare ID - Type UnspecifiedRAILROAD MEDICARE
H94865Medicare UPIN
85-0236178-021OtherMOLINA HEALTHCARE