Organization
HAROLD B.EUDALY JR., M.D.PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAROLD B EUDALY JR. M.D. (OWNER)
(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 PLACE, SUITE 814, FORT WORTH, TX 76116-5704
(817) 763-0022
(817) 763-0027
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C6930
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881792026
OLD NPI
—
Enumeration date
04/22/2009
Last updated
04/22/2009
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