Organization
HAROLD B. EUDALY, JR., MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAROLD B EUDALY JR. MD (MD)
(817) 763-0022
Entity
Organization
Contact information
Practice address
6300 RIDGLEA PL, SUITE 814, FORT WORTH, TX 76116-5704
(817) 763-0022
(817) 763-0027
Mailing address
6300 RIDGLEA PL, SUITE 814, FORT WORTH, TX 76116-5704
(817) 763-0022
(817) 763-0027
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C6960
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881792026
NP1
—
01
—
204532929
TAX ID
—
01
—
C6930
TEXAS LICENSE
TX
Enumeration date
12/12/2008
Last updated
12/12/2008
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