Basic Information
| Provider Information | |||||||||
| NPI: | 1003010117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGAR | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A104755 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 57009671 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD28723 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD28723 | 01 | OR | STATE LICENSE | OTHER | A104755 | 01 | CA | STATE LICENSE | OTHER | 91143 | 01 | OH | OHIO LICENCE | OTHER | FE0701878 | 01 | DEA | OTHER | 026065 | 05 | OR | MEDICAID | 2836739 | 05 | OH | MEDICAID |