Provider Demographics
NPI:1558418590
Name:EGAN, JOHN CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CRAIG
Last Name:EGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:602-933-1820
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:# 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-254-5561
Practice Address - Fax:602-254-2185
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI491270202086S0120X
AZ403882086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ337256Medicaid
AZZ122210Medicare PIN