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Individual

MARK T EGGLESTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 PORT DRIVE, CLARKSTON, WA 99403-1835
(509) 758-8811
(509) 751-1188
Mailing address
500 PORT DRIVE, CLARKSTON, WA 99403-1835
(509) 758-8811
(509) 751-1188

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
M8239
ID
207W00000X
Ophthalmology Physician
Primary
MD00039323
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000100033114
FEDERAL BLUE CROSS
01
000010033114
REGENCE BLUE SHIELD OF IDAHO
ID
01
000010145029
REGENCE BLUE SHIELD OF IDAHO
ID
01
0152789
LABOR & INDUSTRY
WA
01
24509
GROUP HEALTH COOPERATIVE
WA
01
42663
BLUE CROSS OF IDAHO
ID
05
806011100
ID
05
8293425
WA
01
8928983
CRIME VICTIMES COMPENSATION ACT
WA
01
BYHD5
BLUE CROSS OF IDAHO
ID
01
MXXPR0054708
MOLINA HEALTHCARE
WA
Enumeration date
10/26/2005
Last updated
04/30/2008
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