MEDICARE: MR. RICARDO BROWNLEE EUSEBIO MD

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	2086S0120X	Pediatric Surgery Physician	M-1017	GU
2	2086S0129X	Vascular Surgery Physician	M-1017	GU
3	208600000X	Surgery Physician	M-1017	GU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10M1017A	OTHER	GU	CONTROLLED SUBSTANCE DEPT
2	M001017	OTHER	GU	MEDICAL LICENSE GUAM BOAR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679795603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICARDO BROWNLEE EUSEBIO MD

Provider Business Mailing Address
First Line	:	633 GOV CARLOS CAMACHO ROAD
Second Line	:	STE 202
City	:	TAMUNING
State	:	GU
Zip	:	86913-3143
Country	:	US
Telephone Number	:	671-646-0443
Fax Number	:	671-646-0440

Provider Business Practice Location Address
First Line	:	633 GOV CARLOS CAMACHO ROAD
Second Line	:	STE 202
City	:	TAMUNING
State	:	GU
Zip	:	86913-3143
Country	:	US
Telephone Number	:	671-646-0443
Fax Number	:	671-646-0440

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/07/2023

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