Provider Demographics
NPI:1518302850
Name:EGGLESTON, DAREK (DO)
Entity Type:Individual
Prefix:
First Name:DAREK
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3600
Mailing Address - Fax:801-475-3601
Practice Address - Street 1:1100 W 2700 N
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-4791
Practice Address - Country:US
Practice Address - Phone:801-475-3600
Practice Address - Fax:801-475-3601
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5398472-1204207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000094808Medicare PIN