Provider Demographics
NPI:1275635054
Name:TILTON, EUGENE BENJAMIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:BENJAMIN
Last Name:TILTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4720 I 10 SERVICE RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MATAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1242
Mailing Address - Country:US
Mailing Address - Phone:504-456-0212
Mailing Address - Fax:504-455-6513
Practice Address - Street 1:4720 I 10 SERVICE RD
Practice Address - Street 2:SUITE 410
Practice Address - City:MATAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1242
Practice Address - Country:US
Practice Address - Phone:504-456-0212
Practice Address - Fax:504-455-6513
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD01127207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15855OtherBLUE CROSS BLUE SHIELD
LA1343587Medicaid
LA012914OtherEAST JEFFERSON HOSPITAL
LA1343587Medicaid
C67690Medicare UPIN