Provider Demographics
NPI:1568678860
Name:EGGLESTON, DEBERA H (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBERA
Middle Name:H
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 SILVERLEAF CT
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-9797
Mailing Address - Country:US
Mailing Address - Phone:517-339-4140
Mailing Address - Fax:
Practice Address - Street 1:400 S PINE ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-2250
Practice Address - Country:US
Practice Address - Phone:517-335-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine