Individual
GLORIA JEAN EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1200 W MOHAVE RD, PARKER, AZ 85344-6349
(928) 669-7380
(928) 669-7371
Mailing address
400 S CALIFORNIA AVE, PARKER, AZ 85344-4467
(928) 669-6151
(928) 669-8403
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1932
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158539
—
AZ
01
—
A20324620
BLUE CROSS BLUE SHEILD
AZ
01
—
P00279265
RAIL ROAD MEDICARE
AZ
Enumeration date
03/24/2006
Last updated
07/05/2022
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