Provider Demographics
NPI:1518051556
Name:RODILLO, EUGENE SUAREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:SUAREZ
Last Name:RODILLO
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:P.O. BOX 1206
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-1206
Mailing Address - Country:US
Mailing Address - Phone:864-446-8800
Mailing Address - Fax:864-446-8178
Practice Address - Street 1:111 SOUTH WEBB STREET
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643
Practice Address - Country:US
Practice Address - Phone:706-376-8030
Practice Address - Fax:706-376-7537
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023217282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD42340Medicare UPIN