Provider Demographics
NPI:1245261049
Name:STUEBEN, EUGENE T (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:T
Last Name:STUEBEN
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 1:601 W ST MARY BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-235-7824
Mailing Address - Fax:337-233-5408
Practice Address - Street 1:601 W ST MARY BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-235-7824
Practice Address - Fax:337-233-5408
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013279207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1182907Medicaid
B65094Medicare UPIN
LA1182907Medicaid