Provider Demographics
NPI:1326196957
Name:LEBAUER, EUGENE SHANER (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:SHANER
Last Name:LEBAUER
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 1:3201 BRASSFIELD RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9682
Mailing Address - Country:US
Mailing Address - Phone:336-282-2300
Mailing Address - Fax:336-282-0034
Practice Address - Street 1:3201 BRASSFIELD RD
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9682
Practice Address - Country:US
Practice Address - Phone:336-282-2300
Practice Address - Fax:336-282-0034
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14712207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
32679OtherWELLPATH
NC51330OtherNC BLUE CROSS BLUE SHIELD
0207779OtherUNITED HEALTHCARE
82551OtherMEDCOST
NC8951330Medicaid
NC208140CMedicare PIN
82551OtherMEDCOST