Provider Demographics
NPI:1245230382
Name:YAMAGUCHI, EUGENE YUKIO (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:YUKIO
Last Name:YAMAGUCHI
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 1:1275 WALLACE RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3007
Mailing Address - Country:US
Mailing Address - Phone:503-371-3232
Mailing Address - Fax:503-375-2398
Practice Address - Street 1:1275 WALLACE RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3007
Practice Address - Country:US
Practice Address - Phone:503-371-3232
Practice Address - Fax:503-375-2398
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR107490Medicaid
OR107490Medicaid
C91345Medicare UPIN