Provider Demographics
NPI:1366529216
Name:EGGLESTON, JOHN M III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:EGGLESTON
Suffix:III
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 1:12201 RENFERT WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5367
Mailing Address - Country:US
Mailing Address - Phone:512-763-4545
Mailing Address - Fax:512-763-4546
Practice Address - Street 1:12201 RENFERT WAY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5367
Practice Address - Country:US
Practice Address - Phone:512-763-4545
Practice Address - Fax:512-762-4546
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6381208200000X, 2082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX299159YTR7Medicare PIN
H48648Medicare UPIN