Healthcare Provider Details

I. General information

NPI: 1295798767
Provider Name (Legal Business Name): JEFF L. EGGART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 GLENNS BAY RD
SURFSIDE BEACH SC
29575-4833
US

IV. Provider business mailing address

1945 GLENNS BAY RD
SURFSIDE BEACH SC
29575-4833
US

V. Phone/Fax

Practice location:
  • Phone: 843-650-1700
  • Fax: 843-650-4228
Mailing address:
  • Phone: 843-650-1700
  • Fax: 843-650-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9990
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: