Healthcare Provider Details

I. General information

NPI: 1891758223
Provider Name (Legal Business Name): EUGENE C HANSBROUGH, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 LESTER ST
POPLAR BLUFF MO
63901-5025
US

IV. Provider business mailing address

PO BOX 550
POPLAR BLUFF MO
63902-0550
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-9955
  • Fax:
Mailing address:
  • Phone: 573-785-4601
  • Fax: 573-686-0178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36376
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE HANSBROUGH
Title or Position: OWNER
Credential: MD
Phone: 573-785-9955