Provider Demographics
NPI:1861464828
Name:HANSBROUGH, EUGENE (MD)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:HANSBROUGH
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 1:411 EAST HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401
Mailing Address - Country:US
Mailing Address - Phone:573-718-8234
Mailing Address - Fax:
Practice Address - Street 1:411 E HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4070
Practice Address - Country:US
Practice Address - Phone:573-718-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP432207X00000X
KY43831207X00000X
MO36376207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202401709Medicaid
KY000000677389OtherANTHEM
KY7100138530Medicaid
KYP400025775Medicare PIN
MO001013697Medicare ID - Type Unspecified
MO202401709Medicaid