Basic Information
Provider Information
NPI: 1003010117
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EGAR
FirstName: JOHN
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 24410
Address2:  
City: EUGENE
State: OR
PostalCode: 974020451
CountryCode: US
TelephoneNumber: 5419844301
FaxNumber:  
Practice Location
Address1: 380 9TH STREET
Address2:  
City: FLORENCE
State: OR
PostalCode: 974399470
CountryCode: US
TelephoneNumber: 5419977134
FaxNumber: 5419021642
Other Information
ProviderEnumerationDate: 06/13/2007
LastUpdateDate: 11/29/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA104755CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XMD28723ORY Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X57009671OHN Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
FE070187801 DEAOTHER
02606505OR MEDICAID
283673905OH MEDICAID
A10475501CASTATE LICENSEOTHER
9114301OHOHIO LICENCEOTHER
MD2872301ORSTATE LICENSEOTHER


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