Provider Demographics
NPI:1285747089
Name:O'HEA, EUGENE KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KEVIN
Last Name:O'HEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 MANILA ST
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-6505
Mailing Address - Country:US
Mailing Address - Phone:601-947-3377
Mailing Address - Fax:601-947-3380
Practice Address - Street 1:697 MANILA ST
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6505
Practice Address - Country:US
Practice Address - Phone:601-947-3377
Practice Address - Fax:601-947-3380
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2019-10-17
Deactivation Date:2019-09-13
Deactivation Code:
Reactivation Date:2019-09-30
Provider Licenses
StateLicense IDTaxonomies
MS14808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0117316Medicaid
MS010056457OtherPALMETTO GBA MEDICARE
MSC00960OtherMEDICARE CAHABA
MSCN0018OtherPALMETTO RAILROAD GROUP
MS010056457OtherPALMETTO GBA MEDICARE
MSCN0018OtherPALMETTO RAILROAD GROUP