Provider Demographics
NPI:1881682201
Name:LOU, EUGENE C (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:C
Last Name:LOU
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:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 GESSNER RD STE 470
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2566
Practice Address - Country:US
Practice Address - Phone:713-722-7454
Practice Address - Fax:713-932-6056
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2954207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096442105Medicaid
TXG67460Medicare UPIN
TXLO081378GMedicare ID - Type Unspecified