Provider Demographics
NPI: | 1386639656 |
---|---|
Name: | EAGAN, MARGARET ANNE (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | MARGARET |
Middle Name: | ANNE |
Last Name: | EAGAN |
Suffix: | |
Gender: | F |
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: | 221 E OAK ST UNIT D |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT COLLINS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80524-3969 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 201 CALIFORNIA ST STE 1300 |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94111-5015 |
Practice Address - Country: | US |
Practice Address - Phone: | 844-847-8216 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-13 |
Last Update Date: | 2023-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 33365 | 207R00000X, 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CO | 67705821 | Medicaid | |
CO | 67705821 | Medicaid | |
CO | P0108457 | Medicare PIN | |
G19707 | Medicare UPIN |