1821088147 NPI number — MR. RICHARD J EGGLESTON MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821088147 NPI number — MR. RICHARD J EGGLESTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGGLESTON
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
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:
1821088147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 PORT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99403-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-758-8811
Provider Business Mailing Address Fax Number:
509-751-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 PORT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-758-8811
Provider Business Practice Location Address Fax Number:
509-751-1188
Provider Enumeration Date:
10/27/2005

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: 207W00000X , with the licence number:  MD00014109 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: M3387 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000010145028 . This is a "REGENCE BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: BYHC7 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010002377 . This is a "REGENCE BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 20031 . This is a "MEDICAL EYE SERVICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MSIWAE400 . This is a "MOLINA HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 33878 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 00010002377 . This is a "FEDERAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8927760 . This is a "CRIME VICTIMS COMPENSATION ACT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 123142 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 12943 . This is a "GROUP HEALTH COOPERATIVE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 15192 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 003681500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1051481 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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