Healthcare Provider Details

I. General information

NPI: 1316056567
Provider Name (Legal Business Name): EUGENE CONTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 KINGSRIDGE DR STE 104
CENTERVILLE OH
45458-1632
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7176
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-1433
  • Fax: 937-439-7443
Mailing address:
  • Phone: 407-875-2080
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34003451
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1889
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: