Healthcare Provider Details

I. General information

NPI: 1932315629
Provider Name (Legal Business Name): RUSSELL WILLIAM EGGERT M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORIDA DEPT HEALTH 4052 BALD CYPRESS WAY, BIN A23
TALLAHASSEE FL
32399-1748
US

IV. Provider business mailing address

FLORIDA DEPT HEALTH 4052 BALD CYPRESS WAY, BIN A23
TALLAHASSEE FL
32399-1748
US

V. Phone/Fax

Practice location:
  • Phone: 850-245-4787
  • Fax: 850-922-0462
Mailing address:
  • Phone: 850-245-4787
  • Fax: 850-922-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 53875
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME 53875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: