Provider Demographics
NPI:1821091612
Name:SPIOTTA, EUGENE J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:J
Last Name:SPIOTTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5212
Mailing Address - Country:US
Mailing Address - Phone:901-761-2100
Mailing Address - Fax:901-682-9351
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5212
Practice Address - Country:US
Practice Address - Phone:901-761-2100
Practice Address - Fax:901-682-9351
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD008432207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006943OtherBLUE CROSS BLUE SHIELD
1210649OtherUNITED HEALTHCARE
2567047001OtherCIGNA
4385995OtherAETNA
TN3179551Medicare ID - Type Unspecified
2567047001OtherCIGNA
TN2006943OtherBLUE CROSS BLUE SHIELD