Provider Demographics
NPI:1932168986
Name:GIDDENS, EUGENE M (MD)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:M
Last Name:GIDDENS
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 1:920 DOUG WHITE DR STE 460
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-449-2336
Mailing Address - Fax:843-497-0625
Practice Address - Street 1:920 DOUG WHITE DR STE 460
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-449-2336
Practice Address - Fax:843-497-0625
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15143207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0604782OtherPHP
SC1000742OtherEVOLUTIONS
SC015143600Medicaid
PA01838955Medicaid
SC5402760OtherAETNA
WV1061024OtherWORK COMP
NC690570YMedicaid
SC0604782OtherPHP
SC015143600Medicaid