Basic Information
| Provider Information | |||||||||
| NPI: | 1871552315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGGE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 VERDAE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296074021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642720388 | ||||||||
| FaxNumber: | 8642139237 | ||||||||
| Practice Location | |||||||||
| Address1: | 3020 REIDVILLE RD STE B | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293015641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642720388 | ||||||||
| FaxNumber: | 8642139237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35046 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 200200516 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 350462 | 05 | SC | MEDICAID | 89131JH | 05 | NC | MEDICAID |