Individual
MR. JOHN P EGAN JR.
Active
Individual
MR. JOHN P EGAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4301048705
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2803005
—
MI
01
—
MI1763
MEDICARE GROUP PTAN
MI
Enumeration date
10/31/2005
Last updated
02/19/2014
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