Provider Demographics
NPI:1568536076
Name:TRUCHELUT, GENE ANTON (MD)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:ANTON
Last Name:TRUCHELUT
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 1:727 VASSAR ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4920
Mailing Address - Country:US
Mailing Address - Phone:407-849-0330
Mailing Address - Fax:407-849-0351
Practice Address - Street 1:727 VASSAR ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4920
Practice Address - Country:US
Practice Address - Phone:407-849-0330
Practice Address - Fax:407-849-0351
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069549100Medicaid
057055Medicare UPIN
FL069549100Medicaid