Provider Demographics
NPI:1891777124
Name:EGERTER, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:EGERTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7750 COLLEGE TOWN DR
Mailing Address - Street 2:102
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2356
Mailing Address - Country:US
Mailing Address - Phone:916-444-0889
Mailing Address - Fax:916-444-6016
Practice Address - Street 1:7750 COLLEGE TOWN DR
Practice Address - Street 2:102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2356
Practice Address - Country:US
Practice Address - Phone:916-444-0889
Practice Address - Fax:916-444-6016
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56649207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029350Medicaid
CAGR0029350Medicaid
CAZZZ16550ZMedicare PIN