MEDICARE: N FRED EAGLSTEIN DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679574164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N FRED EAGLSTEIN DO PA

Provider Business Mailing Address
First Line	:	2055 PROFESSIONAL CENTER DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4461
Country	:	US
Telephone Number	:	904-276-4500
Fax Number	:	904-276-4160

Provider Business Practice Location Address
First Line	:	2055 PROFESSIONAL CENTER DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4461
Country	:	US
Telephone Number	:	904-276-4500
Fax Number	:	904-276-4160

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	N FRED EAGLSTEIN
Credential	:	DO
Telephone Number	:	904-276-4500

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/10/2008

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Directions to “N FRED EAGLSTEIN DO PA ” Practice Location

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