Provider Demographics
NPI:1588742498
Name:EGGEN, GILBERT (DO)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:EGGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3509 COFFEE RD
Mailing Address - Street 2:STE D18
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1358
Mailing Address - Country:US
Mailing Address - Phone:209-523-7297
Mailing Address - Fax:209-523-7299
Practice Address - Street 1:3509 COFFEE RD
Practice Address - Street 2:STE D18
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1358
Practice Address - Country:US
Practice Address - Phone:209-523-7297
Practice Address - Fax:209-523-7299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A45102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry