Provider Demographics
NPI:1558371740
Name:EGGER, ROSS L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:L
Last Name:EGGER
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 1:602 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47356-1008
Mailing Address - Country:US
Mailing Address - Phone:765-354-2062
Mailing Address - Fax:765-354-4679
Practice Address - Street 1:602 N 5TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356-1008
Practice Address - Country:US
Practice Address - Phone:765-354-2062
Practice Address - Fax:765-354-4679
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019753A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01019753BOtherCSR
IN01019753BOtherCSR
INBE2414439OtherDEA
IN353810AMedicare ID - Type Unspecified