Healthcare Provider Details

I. General information

NPI: 1043257587
Provider Name (Legal Business Name): LARRY DUANE EGGERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S 400 E NEONATOLOGY
SAINT GEORGE UT
84770-3705
US

IV. Provider business mailing address

544 S 400 E NEONATOLOGY
SAINT GEORGE UT
84770-3705
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-5447
  • Fax:
Mailing address:
  • Phone: 435-688-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number162609-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number19146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: