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General NPI Number Information
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NPI Number | 1891758223
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Entity Type | Organization
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Legal Business Name | EUGENE C HANSBROUGH, MD LLC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 686 LESTER ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-5025
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Country | US
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Telephone | 573-785-9955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | POPLAR BLUFF
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State | MO
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Zip | 63902-0550
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Country | US
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Telephone | 573-785-4601
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Fax | 573-686-0178
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUGENE HANSBROUGH
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Credential | MD
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Telephone | 573-785-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 36376
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License Number State | MO
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