Healthcare Provider Details

I. General information

NPI: 1689677106
Provider Name (Legal Business Name): EUGENE J MCCABE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 FAIRGROUNDS RD
SAINT CHARLES MO
63301-2338
US

IV. Provider business mailing address

1005 FAIRGROUNDS RD
SAINT CHARLES MO
63301-2338
US

V. Phone/Fax

Practice location:
  • Phone: 636-724-7116
  • Fax: 636-916-4627
Mailing address:
  • Phone: 636-724-7116
  • Fax: 636-916-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR9550
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: