Provider Demographics
NPI:1588826259
Name:EUGENE D. CHEN, MD. PLLC
Entity Type:Organization
Organization Name:EUGENE D. CHEN, MD. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:DUNYO
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-281-7776
Mailing Address - Street 1:PO BOX 2101
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-0101
Mailing Address - Country:US
Mailing Address - Phone:808-281-7776
Mailing Address - Fax:580-379-6659
Practice Address - Street 1:1925 E ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3537
Practice Address - Country:US
Practice Address - Phone:808-281-7776
Practice Address - Fax:580-379-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46298208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1943982OtherCOVENTRY
CORR1445OtherRAILROAD MEDICARE
CO17-20896OtherUNITED HEALTH CARE
CO17-20896OtherUNITED HEALTHCARE
CO7143539OtherAETNA
CO74171569Medicaid
CO7143539OtherAETNA