MEDICARE: EUGENE M.R. CHARLEBOIS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	007862	AZ
2	207Q00000X	Family Medicine Physician	1674	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356345383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE M.R. CHARLEBOIS DO

Provider Business Mailing Address
First Line	:	1200 N BEAVER ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3118
Country	:	US
Telephone Number	:	928-213-6235
Fax Number	:	928-213-6292

Provider Business Practice Location Address
First Line	:	3700 W STATE ROUTE 89A
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86336-4937
Country	:	US
Telephone Number	:	928-204-4100
Fax Number	:	928-639-6682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/24/2023

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