=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164489985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE V. ACUPAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 08/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 SIVLEY RD SW
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-4421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-539-9471
-----------------------------------------------------
Fax | 256-539-9472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2006 FRANKLIN ST SE SUITE 301
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-539-9471
-----------------------------------------------------
Fax | 256-539-9472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 00024242
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------