Provider Demographics
NPI:1831134204
Name:MEAD, EUGENE D (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:D
Last Name:MEAD
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 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6079207V00000X
MN47985207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0704470OtherMEDICA #
ND322S6MEOtherMNBS #
ND7714940Medicaid
ND44941OtherLHS #
ND11668Medicaid
ND063H8MEOtherMNBS #
ND140851OtherUCARE #
ND25882OtherNDBS #
ND26679OtherNDBS #
NDDA9051029487OtherPREFERRED ONE #
ND063H9MEOtherMNBS #
ND0704719OtherMEDICA #
ND26507OtherNDBS #
ND449007000Medicaid
NDHP54455OtherHEALTHPARTNERS #
ND26507OtherNDBS #
ND449007000Medicaid
ND140851OtherUCARE #
ND711876Medicare ID - Type UnspecifiedND MEDICARE #
ND7714940Medicaid