Provider Demographics
NPI:1184657538
Name:BELOGORSKY, EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:BELOGORSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W COLLEGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5000
Mailing Address - Country:US
Mailing Address - Phone:707-526-3500
Mailing Address - Fax:707-526-2358
Practice Address - Street 1:585 W COLLEGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5000
Practice Address - Country:US
Practice Address - Phone:707-526-3500
Practice Address - Fax:707-526-2358
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29625207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51167ZOtherGROUPONE HEALTHSOURCE LLC
CA00G296253Medicaid
CAZZZ51167ZOtherGROUPONE HEALTHSOURCE LLC
CA00G296253Medicaid