Eugene Raphael Valentine, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME12756 Issued in FL

Practice address

235 Carmel Dr
Fort Walton Beach, FL 32547-1957

Phone

(850) 862-3141

Fax

(850) 862-7732

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263859200000",
    "number": "1376561159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 CARMEL DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471957",
            "telephone_number": "850-862-3141",
            "fax_number": "850-862-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 CARMEL DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471957",
            "telephone_number": "850-862-3141",
            "fax_number": "850-862-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALENTINE",
        "first_name": "EUGENE",
        "middle_name": "RAPHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2010-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME12756",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME12756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "46079",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "052428000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Tymon
• Devang Yogeshbhai Undaviya
• Suzy Urenda
• Aimee Pooneh Vafaie, MD
• Alexandra Jean Valencik, CRNA
• Chinh Vien Van, M.D.
• Mary Forsyth Vasiloff, AU.D.
• Angela Patricia Vaughn, RBT
• Lauren Z Veal, M.S.- CCC/SLP
• Andres Tomas Vega, DO

• Child & Adolescent Psychiatry Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.