Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS020691L | PA |
NPI | 1013350057 |
---|---|
Provider Name | Gary Ross Eggler |
First Address | Indiana, PA 15701-3662 |
Second Address | Indiana, PA 15701-3662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2013 |
Last Update Date | 09/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T28296 | (02) |