Provider Demographics
NPI:1356345383
Name:CHARLEBOIS, EUGENE MR (DO)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:MR
Last Name:CHARLEBOIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:3700 W STATE ROUTE 89A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4937
Practice Address - Country:US
Practice Address - Phone:928-204-4100
Practice Address - Fax:928-639-6682
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007862207P00000X
ME1674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ546268Medicaid
ME33604099Medicaid
ME33604099Medicaid