=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295820025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD T. EGAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 02/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 BOB MARSHALL PL
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59404-6432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-727-5939
-----------------------------------------------------
Fax | 406-727-5939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 BOB MARSHALL PL
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59404-6432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-727-5939
-----------------------------------------------------
Fax | 406-727-5939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 8018
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 8018
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------