Provider Demographics
NPI:1114979606
Name:EGGLESTON, STEVEN DALE (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DALE
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217A OAK DR S
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5675
Mailing Address - Country:US
Mailing Address - Phone:979-299-3100
Mailing Address - Fax:979-266-9598
Practice Address - Street 1:217A OAK DR S
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5675
Practice Address - Country:US
Practice Address - Phone:979-299-3100
Practice Address - Fax:979-266-9598
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6368207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167314701Medicaid
TX167314701Medicaid
TX8A9460Medicare ID - Type Unspecified