Provider Demographics
NPI:1295820025
Name:EGAN, RONALD T (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:EGAN
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 1:5 BOB MARSHALL PL
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6432
Mailing Address - Country:US
Mailing Address - Phone:406-727-5939
Mailing Address - Fax:406-727-5939
Practice Address - Street 1:5 BOB MARSHALL PL
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-6432
Practice Address - Country:US
Practice Address - Phone:406-727-5939
Practice Address - Fax:406-727-5939
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT80182085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0100351Medicaid
G38436Medicare UPIN
CAFR761ZMedicare PIN
MO0100351Medicaid