MEDICARE: RICARDO B. EUSEBIO, M.D.

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	208600000X	Surgery Physician	M001017	GU

Other Identifiers

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

General Provider Information

NPI Number	:	1851574594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO B. EUSEBIO, M.D.

Provider Business Mailing Address
First Line	:	633 GOVERNOR CARLOS CAMACHO ROAD
Second Line	:	STE. 202
City	:	TAMUNING
State	:	GU
Zip	:	96913-3143
Country	:	US
Telephone Number	:	671-646-0443
Fax Number	:	671-646-0440

Provider Business Practice Location Address
First Line	:	GUAM MEDICAL PLAZA 633 GOVERNOR CARLOS CAMACHO ROAD
Second Line	:	STE. 202
City	:	TAMUNING
State	:	GU
Zip	:	96913-3143
Country	:	US
Telephone Number	:	671-646-0443
Fax Number	:	671-646-0440

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. RICARDO BROWNLEE EUSEBIO
Credential	:	M.D.
Telephone Number	:	671-646-0443

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	03/07/2023

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