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General NPI Number Information
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NPI Number | 1770574790
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Entity Type | Individual
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Provider Name | EUGENE C FLETCHER MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 1600 GOSHEN LN
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City | GOSHEN
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State | KY
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Zip | 40026-9509
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Country | US
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Telephone | 502-228-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 GOSHEN LN
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City | GOSHEN
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State | KY
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Zip | 40026-9509
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Country | US
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Telephone | 520-228-2636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 01046080A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 29686
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 01046080A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 29686
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License Number State | KY
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