Provider Demographics
NPI:1346570272
Name:STILL, EUGENE FONTAINE II (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:FONTAINE
Last Name:STILL
Suffix:II
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 1:8416 MILE TREE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4319
Mailing Address - Country:US
Mailing Address - Phone:479-478-9936
Mailing Address - Fax:
Practice Address - Street 1:8416 MILE TREE DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4319
Practice Address - Country:US
Practice Address - Phone:479-478-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-25
Last Update Date:2009-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19206208200000X
ARC-40582082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery