1750318036 NPI number — DANIEL E EGGLESTON MD

Table of content: DANIEL E EGGLESTON MD (NPI 1750318036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750318036 NPI number — DANIEL E EGGLESTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGGLESTON
Provider First Name:
DANIEL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750318036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38339 S GRANITE CREST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-530-6692
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38339 S GRANITE CREST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-530-6692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006

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: 2085P0229X , with the licence number:  46562 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 46562 , 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)

  • Identifier: Z93002 . This is a "PHYSICIAN INDIVIDUAL MEDICARE ID #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: ZWCBBM . This is a "GROUP MEDICARE ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 005472 . This is a "GROUP MEDICAID ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 769433 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750318036 . This is a "PHYSICIAN INDIVIDUAL NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1841261989 . This is a "GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: CS7943 . This is a "GROUP MEDICARE RAILROAD ID & PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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