Basic Information
| Provider Information | |||||||||
| NPI: | 1740296706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGAN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 919379 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328919379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444531406 | ||||||||
| FaxNumber: | 7726213180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 7TH AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278251100 | ||||||||
| FaxNumber: | 7278275155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | ME0041215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | ME0041215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | ME0041215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0204X | ME0041215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | ME0041215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME41215 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | ME0041215 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 62407 | 01 | FL | FL BCBS | OTHER | 300003302 | 01 | FL | FL RAILROAD MEDICARE | OTHER | 046909200 | 05 | FL | MEDICAID | 62407Z | 01 | FL | FL MEDICARE PTAN | OTHER |