Provider Demographics
NPI:1548470826
Name:EUGENE D. EDDLEMON, M.D., INC.
Entity type:Organization
Organization Name:EUGENE D. EDDLEMON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:EDDLEMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-345-9455
Mailing Address - Street 1:95 DECLARATION DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4916
Mailing Address - Country:US
Mailing Address - Phone:530-345-9455
Mailing Address - Fax:530-345-6628
Practice Address - Street 1:95 DECLARATION DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4916
Practice Address - Country:US
Practice Address - Phone:530-345-9455
Practice Address - Fax:530-345-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68376208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G683761Medicaid
DA8636OtherRAILROAD MEDICARE
CAG68376OtherSTATE LICENSE
DA8636OtherRAILROAD MEDICARE
CAE58074Medicare UPIN