Provider Demographics
NPI:1437267689
Name:FEALK, EUGENE LEWIS (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:LEWIS
Last Name:FEALK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:1420 ROCKY RIDGE DR STE 230
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2835
Practice Address - Country:US
Practice Address - Phone:916-783-9697
Practice Address - Fax:916-783-9721
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A61822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB46548Medicare UPIN