Provider Demographics
NPI:1518205756
Name:WILLETT, EUGENE STANLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:STANLEY
Last Name:WILLETT
Suffix:JR
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 1:38 PEACH KNOB DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2946
Mailing Address - Country:US
Mailing Address - Phone:828-258-8543
Mailing Address - Fax:828-252-4670
Practice Address - Street 1:38 PEACH KNOB DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2946
Practice Address - Country:US
Practice Address - Phone:828-258-8543
Practice Address - Fax:828-252-4670
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21137207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC89513Medicare UPIN