Provider Demographics
NPI:1770574790
Name:FLETCHER, EUGENE C (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:C
Last Name:FLETCHER
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 1:1600 GOSHEN LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-9509
Mailing Address - Country:US
Mailing Address - Phone:520-228-2636
Mailing Address - Fax:
Practice Address - Street 1:1600 GOSHEN LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:KY
Practice Address - Zip Code:40026-9509
Practice Address - Country:US
Practice Address - Phone:502-228-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046080A207RC0200X, 207RP1001X
KY29686207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000645210OtherANTHEM BCBS
KY2444577000OtherPASSPOSRT ADVANTAGE
KY64296866Medicaid
KY000000311476OtherANTHEM
KY50003129OtherPASSPORT
IN200057650BMedicaid
INB95658Medicare UPIN
KY0791101Medicare PIN
KYP00070122Medicare PIN
IN000000645210OtherANTHEM BCBS
KY000000311476OtherANTHEM