Provider Demographics
NPI:1467444380
Name:ROOS, EUGENE H (DO)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:H
Last Name:ROOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-5000
Mailing Address - Country:US
Mailing Address - Phone:661-326-2334
Mailing Address - Fax:661-326-2982
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:949-326-2334
Practice Address - Fax:661-326-2982
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A63262085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX63260Medicaid
W20A6326BMedicare PIN
C33309Medicare UPIN
020A63263Medicare PIN
W20A6326AMedicare PIN