Provider Demographics
NPI:1326234782
Name:EGAN, DAVID M (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:EGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12314 W 73RD TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-3673
Mailing Address - Country:US
Mailing Address - Phone:913-558-3519
Mailing Address - Fax:913-499-0781
Practice Address - Street 1:12314 W 73RD TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-3673
Practice Address - Country:US
Practice Address - Phone:913-558-3519
Practice Address - Fax:913-499-0781
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0259103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist