Provider Demographics
NPI:1356454581
Name:NGO, EUGENIA JANE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:JANE
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EUGENIA
Other - Middle Name:JANE
Other - Last Name:NGO-SEIDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:30 S. 4TH STREET
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-0517
Mailing Address - Country:US
Mailing Address - Phone:904-548-1800
Mailing Address - Fax:904-277-7286
Practice Address - Street 1:86014 PAGES DAIRY RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5203
Practice Address - Country:US
Practice Address - Phone:904-548-1880
Practice Address - Fax:904-225-0250
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120978500Medicaid
FL064161800Medicaid
FLD51867Medicare UPIN