Provider Demographics
NPI:1346394574
Name:EGGEBROTEN, WILLIAM ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERNEST
Last Name:EGGEBROTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 TATOOSH PL
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1434
Mailing Address - Country:US
Mailing Address - Phone:253-581-6978
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE DEPARTMENT OF SURGERY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1345
Practice Address - Fax:253-968-0232
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00024739208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery