Healthcare Provider Details

I. General information

NPI: 1457419210
Provider Name (Legal Business Name): EUGENE KAPLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ELM ST STE 310
CALDWELL ID
83605-4881
US

IV. Provider business mailing address

PO BOX 742941
ATLANTA GA
30374-2941
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-2035
  • Fax: 208-454-1065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA67292
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberM-15625
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: