Basic Information
| Provider Information | |||||||||
| NPI: | 1518166404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGLY | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6451 BRENTWOOD STAIR RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761123200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174969700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6451 BRENTWOOD STAIR RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761123200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174969700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 01/06/2017 | ||||||||
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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 | 207P00000X | 4301090145 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N6276 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00896828 | 01 | TX | RAILROAD | OTHER | P00896828 | 01 | TX | MEDICARE RAILROAD | OTHER | 215099701 | 05 | TX | MEDICAID |