Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 59120 | MN |
NPI | 1003058496 |
---|---|
Provider Name | David Charles Eggert |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Waconia, MN 55387-1733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 03/08/2015 |