Provider Demographics
NPI:1124232285
Name:EUGENE A. DEGNER MD PA
Entity Type:Organization
Organization Name:EUGENE A. DEGNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-661-7888
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE 525
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-661-7888
Mailing Address - Fax:713-661-7899
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 525
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-661-7888
Practice Address - Fax:713-661-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8944207Q00000X, 207QA0401X
TXL0414207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609965078OtherDR MCQUEENS NPI
TX1851310981OtherDR. DEGNERS NPI
TXB22190Medicare UPIN
TX00U72GMedicare ID - Type UnspecifiedDR. DEGNERS MEDICARE
TX1609965078OtherDR MCQUEENS NPI