Provider Demographics
NPI:1750731683
Name:EUGENIO, RYNEAL N (DO)
Entity type:Individual
Prefix:
First Name:RYNEAL
Middle Name:N
Last Name:EUGENIO
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 1:1601 W TIMBERLANE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0957
Mailing Address - Country:US
Mailing Address - Phone:813-708-1312
Mailing Address - Fax:813-443-8147
Practice Address - Street 1:1601 W TIMBERLANE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0957
Practice Address - Country:US
Practice Address - Phone:813-708-1312
Practice Address - Fax:813-443-8147
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022718208600000X
MO2021009507208600000X
FLOS18734208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200098667Medicaid