Provider Demographics
NPI:1679795603
Name:EUSEBIO, RICARDO BROWNLEE (MD)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:BROWNLEE
Last Name:EUSEBIO
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 1:633 GOV CARLOS CAMACHO ROAD
Mailing Address - Street 2:STE 202
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:86913-3143
Mailing Address - Country:US
Mailing Address - Phone:671-646-0443
Mailing Address - Fax:671-646-0440
Practice Address - Street 1:633 GOV CARLOS CAMACHO ROAD
Practice Address - Street 2:STE 202
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:86913-3143
Practice Address - Country:US
Practice Address - Phone:671-646-0443
Practice Address - Fax:671-646-0440
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-10172086S0120X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU10M1017AOtherCONTROLLED SUBSTANCE DEPT
GUM001017OtherMEDICAL LICENSE GUAM BOAR
GU217Medicaid
GU217Medicaid
F48994Medicare UPIN
GU217Medicaid