Provider Demographics
NPI:1720043375
Name:GUERRE, EUGENE FRANK JR (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:FRANK
Last Name:GUERRE
Suffix:JR
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 1:7005 NIGHTWALKER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6349
Mailing Address - Country:US
Mailing Address - Phone:352-597-7700
Mailing Address - Fax:352-597-9951
Practice Address - Street 1:7005 NIGHTWALKER RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6349
Practice Address - Country:US
Practice Address - Phone:352-597-7700
Practice Address - Fax:352-597-9951
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72863207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252924600Medicaid
FL42273AMedicare PIN
C66197Medicare UPIN