Provider Demographics
NPI:1932315629
Name:EGGERT, RUSSELL WILLIAM (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:EGGERT
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:FLORIDA DEPT HEALTH
Mailing Address - Street 2:4052 BALD CYPRESS WAY, BIN A23
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32399-1748
Mailing Address - Country:US
Mailing Address - Phone:850-245-4787
Mailing Address - Fax:850-922-0462
Practice Address - Street 1:FLORIDA DEPT HEALTH
Practice Address - Street 2:4052 BALD CYPRESS WAY, BIN A23
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32399-1748
Practice Address - Country:US
Practice Address - Phone:850-245-4787
Practice Address - Fax:850-922-0462
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-05-24
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Provider Licenses
StateLicense IDTaxonomies
FLME 53875207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine