Organization
EAGLE IMAGING MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY HABERMAN (AUTHORIZED OFFICIAL)
(714) 571-5000
Entity
Organization
Contact information
Practice address
431 S BATAVIA ST, STE. 103, ORANGE, CA 92868-3936
(714) 538-6731
(714) 771-8369
Mailing address
PO BOX 5989, ORANGE, CA 92863-5989
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0095110
—
CA
05
—
GR0095111
—
CA
05
—
GR0095112
—
CA
05
—
GR0095113
—
CA
Enumeration date
07/10/2007
Last updated
08/18/2008
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