Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | P6381 | TX |
N | 208600000X | Surgeon | P6381 | TX |
N | 2082S0105X | Plastic Hand Surgeon | P6381 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | P6381 | TX |
NPI | 1366529216 |
---|---|
Provider Name | John M. Eggleston III |
First Address | Austin, TX 78758-5367 |
Second Address | Austin, TX 78758-5367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 14/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H48648 | (02) |