Provider Demographics
NPI:1679534366
Name:EUGENIO, EUGENE JONATHAN C (MD)
Entity Type:Individual
Prefix:MR
First Name:EUGENE JONATHAN
Middle Name:C
Last Name:EUGENIO
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 1:2208 TERRANOVA CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1839
Mailing Address - Country:US
Mailing Address - Phone:859-536-4189
Mailing Address - Fax:
Practice Address - Street 1:483 N SEMORAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:321-436-0771
Practice Address - Fax:407-218-8906
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY379012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64075161Medicaid
KY000000331711OtherANTHEM BCBS
KYP00205115OtherRAILROAD MEDICARE
KY611033603OtherHUMANA
KY64075161Medicaid
KY0040621Medicare PIN