Provider Demographics
NPI:1508866880
Name:HADDOCK, EUGENE P (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:P
Last Name:HADDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EUGENE
Other - Middle Name:P
Other - Last Name:HADDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:301 JUNCTION HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 JUNCTION HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4247
Practice Address - Country:US
Practice Address - Phone:830-896-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86050JMedicare PIN