# EUGENE D. EDDLEMON, M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548470826
- **Authorized official:** EUGENE DALE EDDLEMON M.D. (OWNER)
- **Authorized official phone:** (530) 345-9455

## Contact information

- **Practice address:** 95 DECLARATION DR, SUITE 1, CHICO, CA 95973-4916
- **Practice address phone:** (530) 345-9455
- **Practice address fax:** (530) 345-6628
- **Mailing address:** 95 DECLARATION DR, SUITE 1, CHICO, CA 95973-4916
- **Mailing address phone:** (530) 345-9455
- **Mailing address fax:** (530) 345-6628

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | G68376 | CA | — |
| 2086S0129X | Vascular Surgery Physician | G68376 | CA | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G683761 | — | CA |
| 01 | — | DA8636 | RAILROAD MEDICARE | — |
| 01 | — | G68376 | STATE LICENSE | CA |