Provider Demographics
NPI:1265524862
Name:EUGENE, JEAN-MARIE G (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN-MARIE
Middle Name:G
Last Name:EUGENE
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:GREGOIRE
Other - Middle Name:
Other - Last Name:EUGENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1362 SW BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2929
Mailing Address - Country:US
Mailing Address - Phone:772-873-5213
Mailing Address - Fax:772-873-5215
Practice Address - Street 1:1362 SW BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2929
Practice Address - Country:US
Practice Address - Phone:772-873-5213
Practice Address - Fax:772-873-5215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43064208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268016500Medicaid
FL96434PMedicare PIN