Provider Demographics
NPI:1407876949
Name:EGGER, LAWRENCE JAMES (PA9108319)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JAMES
Last Name:EGGER
Suffix:
Gender:M
Credentials:PA9108319
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3000
Mailing Address - Fax:
Practice Address - Street 1:2355 STANFORD CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4813
Practice Address - Country:US
Practice Address - Phone:239-658-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108319363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1667977Medicare ID - Type UnspecifiedCIGNA
1667978Medicare ID - Type UnspecifiedCIGNA
R12274Medicare UPIN
ID1407876949Medicaid
1667978Medicare ID - Type UnspecifiedCIGNA