Provider Demographics
NPI:1063557981
Name:EAGAN, ROGER K (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:K
Last Name:EAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 WHEATON WAY STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3303
Mailing Address - Country:US
Mailing Address - Phone:360-782-5700
Mailing Address - Fax:253-853-8067
Practice Address - Street 1:2512 WHEATON WAY STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-782-5700
Practice Address - Fax:253-853-8067
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047354174400000X, 207RS0012X, 207RP1001X
WA00047354207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1033506Medicaid