Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 40388 | AZ |
N | 2086S0120X | Pediatric Surgery | 49127020 | WI |
NPI | 1558418590 |
---|---|
Provider Name | Dr. John Craig Egan |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 13/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
337256 | (05) | AZ |