Provider Demographics
NPI:1518171552
Name:DAGON, EUGENE M (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:M
Last Name:DAGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:M
Other - Last Name:DAGON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14906 WINDING CREEK COURT
Mailing Address - Street 2:SUITE 102-D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1627
Mailing Address - Country:US
Mailing Address - Phone:813-963-7498
Mailing Address - Fax:813-977-4964
Practice Address - Street 1:14906 WINDING CREEK CT
Practice Address - Street 2:SUITE 102-D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1627
Practice Address - Country:US
Practice Address - Phone:813-963-7498
Practice Address - Fax:813-977-4964
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME452012084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54026Medicare UPIN
30516Medicare ID - Type Unspecified