Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | 00047354 | WA |
Y | 207RP1001X | Pulmonary Disease | MD00047354 | WA |
N | 207RS0012X | Sleep Medicine | MD00047354 | WA |
NPI | 1063557981 |
---|---|
Provider Name | Dr. Roger K Eagan |
First Address | Bremerton, WA 98310-3303 |
Second Address | Bremerton, WA 98310-3303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033506 | (05) | WA |
H75094 | (02) | IN |