Provider Demographics
NPI:1033126834
Name:LANGEVIN, EUGENE E (DO)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:E
Last Name:LANGEVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 W 32ND ST STE 208
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1651
Mailing Address - Country:US
Mailing Address - Phone:417-623-6343
Mailing Address - Fax:417-623-6424
Practice Address - Street 1:1531 W 32ND ST STE 208
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1651
Practice Address - Country:US
Practice Address - Phone:417-623-6343
Practice Address - Fax:417-623-6424
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO32881207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB18497Medicare UPIN