1053327460 NPI number — DR. JOHN CHARLES EGELHOFF D.O.

Table of content: DR. JOHN CHARLES EGELHOFF D.O. (NPI 1053327460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053327460 NPI number — DR. JOHN CHARLES EGELHOFF D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGELHOFF
Provider First Name:
JOHN
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EGELHOFF
Provider Other First Name:
JOHN
Provider Other Middle Name:
CHARLES
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053327460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 E THOMAS RD BLDG 2108
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-512-8029
Provider Business Mailing Address Fax Number:
602-512-8161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 E THOMAS RD
Provider Second Line Business Practice Location Address:
RADIOLOGY
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-7710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-933-1213
Provider Business Practice Location Address Fax Number:
602-933-1214
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X , with the licence number:  34.003661 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: 34.003661 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: 4510 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)