Provider Demographics
NPI:1518057629
Name:SHIEH, EUGENE C (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:C
Last Name:SHIEH
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3343 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8002
Practice Address - Country:US
Practice Address - Phone:561-795-9845
Practice Address - Fax:561-795-8791
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME962502085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP939353OtherOPTIMUM
FLP998277OtherFREEDOM
FL78538OtherBCBS
FLP01627956OtherRR MEDICARE
FL11580OtherDIMENSION HEALTH PPO
FL278840300Medicaid
FL332414OtherAVMED
FL7830888OtherAETNA
FLP998277OtherFREEDOM
FL11580OtherDIMENSION HEALTH PPO
FLU8606RMedicare PIN
FLI66264Medicare UPIN