Provider Demographics
NPI:1538291539
Name:JOHN EUGENE MD INC
Entity Type:Organization
Organization Name:JOHN EUGENE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EUGENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-288-9428
Mailing Address - Street 1:PO BOX 8130
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92812-0130
Mailing Address - Country:US
Mailing Address - Phone:714-288-9428
Mailing Address - Fax:714-288-9430
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 502
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-288-9428
Practice Address - Fax:714-288-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42949Medicare UPIN