Individual
KENNETH J EGLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8508 W GAGE BLVD STE A101, KENNEWICK, WA 99336-8106
(877) 522-1275
(833) 888-7145
Mailing address
5615 DUNBARTON AVE, PASCO, WA 99301-8216
(509) 222-1275
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00041379
WA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
MD00041379
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0227845
LIWA
WA
05
—
8358749
—
WA
01
—
911348529
OTHER INS #
WA
Enumeration date
10/04/2006
Last updated
11/18/2020
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