Healthcare Provider Details

I. General information

NPI: 1679542302
Provider Name (Legal Business Name): EUGENE LU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S. UNIVERSITY SUITE 200
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

500 S. UNIVERSITY SUITE 200
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4117
  • Fax: 501-664-1137
Mailing address:
  • Phone: 501-664-4117
  • Fax: 501-664-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-1742
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: