Provider Demographics
NPI:1912995317
Name:EGGLESTON, HARRY C (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:C
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 790051
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0051
Mailing Address - Country:US
Mailing Address - Phone:314-872-7744
Mailing Address - Fax:314-810-5296
Practice Address - Street 1:633 EMERSON RD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-872-7744
Practice Address - Fax:314-810-5296
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO45050OtherGHP
MOA10830OtherGREATWEST HEALTHCARE
MO101139OtherHEALTHLINK
MO0800077OtherUNITED HEALTHCARE
MO17203OtherBCBS
MO4039678OtherAETNA
MO101139OtherHEALTHLINK