Provider Demographics
NPI:1265528533
Name:EGUIA, JOSE (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:EGUIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-574-5501
Mailing Address - Fax:203-596-0912
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-574-5501
Practice Address - Fax:203-596-0912
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT16601207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14348Medicare UPIN