Basic Information
| Provider Information | |||||||||
| NPI: | 1053327460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGELHOFF | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EGELHOFF | ||||||||
| OtherFirstName: | JOHN | ||||||||
| OtherMiddleName: | CHARLES | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1919 E THOMAS RD BLDG 2108 | ||||||||
| Address2: | 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025128029 | ||||||||
| FaxNumber: | 6025128161 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 E THOMAS RD | ||||||||
| Address2: | RADIOLOGY | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331213 | ||||||||
| FaxNumber: | 6029331214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 34.003661 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085P0229X | 34.003661 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085N0700X | 4510 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.