Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 105445 | MN |
N | 207XS0106X | Orthopaedic Hand Surgeon | 105445 | MN |
N | 207XS0106X | Orthopaedic Hand Surgeon | 54404 | MN |
Y | 2082S0105X | Plastic Hand Surgeon | P3315 | TX |
NPI | 1053433375 |
---|---|
Provider Name | Dr. Brent Michael Egeland |
First Address | Austin, TX 78701-1926 |
Second Address | Austin, TX 78701-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 07/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
ENROLLED | (05) | WI |
P01021688 | RAIL ROAD - MEDICARE (01) | MN |