Healthcare Provider Details

I. General information

NPI: 1881740355
Provider Name (Legal Business Name): EUGENE JOHN CARRAGEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BLAKE WILBUR DR FIRST FLOOR MC 5311
PALO ALTO CA
94304-2201
US

IV. Provider business mailing address

300 PASTEUR DR EDWARDS R171 MC 5326
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-6797
  • Fax: 650-723-9805
Mailing address:
  • Phone: 650-725-6797
  • Fax: 650-723-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG51842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: