Basic Information
| Provider Information | |||||||||
| NPI: | 1184657538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELOGORSKY | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 585 W COLLEGE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954015000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075263500 | ||||||||
| FaxNumber: | 7075262358 | ||||||||
| Practice Location | |||||||||
| Address1: | 585 W COLLEGE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954015000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075263500 | ||||||||
| FaxNumber: | 7075262358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | G29625 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | ZZZ51167Z | 01 | CA | GROUPONE HEALTHSOURCE LLC | OTHER | 00G296253 | 05 | CA | MEDICAID |