Provider Demographics
NPI:1750318036
Name:EGGLESTON, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:EGGLESTON
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 1:38339 S GRANITE CREST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739
Mailing Address - Country:US
Mailing Address - Phone:313-530-6692
Mailing Address - Fax:
Practice Address - Street 1:38339 S GRANITE CREST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739
Practice Address - Country:US
Practice Address - Phone:313-530-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ465622085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ93002OtherPHYSICIAN INDIVIDUAL MEDICARE ID #
AZZWCBBMOtherGROUP MEDICARE ID
AZ005472OtherGROUP MEDICAID ID
AZ769433Medicaid
AZ1750318036OtherPHYSICIAN INDIVIDUAL NPI
AZ1841261989OtherGROUP NPI
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZ769433Medicaid