Provider Demographics
NPI:1891951349
Name:EUGENE, SHIRLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:EUGENE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DELHI ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6320
Mailing Address - Country:US
Mailing Address - Phone:563-589-4066
Mailing Address - Fax:563-589-4063
Practice Address - Street 1:1515 DELHI ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6320
Practice Address - Country:US
Practice Address - Phone:563-589-4066
Practice Address - Fax:563-589-4063
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1891951349Medicaid
IA1891951349OtherWELLMARK BLUE CROSS BLUES SHIELD
IA511790024Medicare PIN