Organization
EUGENE D. EDDLEMON, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE DALE EDDLEMON M.D. (OWNER)
(530) 345-9455
Entity
Organization
Contact information
Practice address
95 DECLARATION DR, SUITE 1, CHICO, CA 95973-4916
(530) 345-9455
(530) 345-6628
Mailing address
95 DECLARATION DR, SUITE 1, CHICO, CA 95973-4916
(530) 345-9455
(530) 345-6628
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
G68376
CA
2086S0129X
Vascular Surgery Physician
Primary
G68376
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G683761
—
CA
01
—
DA8636
RAILROAD MEDICARE
—
01
—
G68376
STATE LICENSE
CA
Enumeration date
05/23/2007
Last updated
06/21/2018
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