Provider Demographics
NPI:1215039433
Name:HERZOG, EUGENE A (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:A
Last Name:HERZOG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241
Mailing Address - Country:US
Mailing Address - Phone:940-665-5543
Mailing Address - Fax:940-665-8404
Practice Address - Street 1:302 SOUTH GRAND
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240
Practice Address - Country:US
Practice Address - Phone:940-665-5543
Practice Address - Fax:940-665-8404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6808TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091986201Medicaid
TX091986201Medicaid
D97395Medicare UPIN