Provider Demographics
NPI:1891765137
Name:EGERER, JAMES PATRICK (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:EGERER
Suffix:
Gender:M
Credentials:PA
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 15692
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5692
Mailing Address - Country:US
Mailing Address - Phone:910-617-8995
Mailing Address - Fax:
Practice Address - Street 1:1615 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7405
Practice Address - Country:US
Practice Address - Phone:910-762-5588
Practice Address - Fax:910-762-5589
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101143363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS78241Medicare UPIN
NC2757452Medicare PIN