Provider Demographics
NPI:1548231806
Name:FLETCHER, EUGENE H (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:H
Last Name:FLETCHER
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 1:566 N KIMBALL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6880
Mailing Address - Country:US
Mailing Address - Phone:469-955-5223
Mailing Address - Fax:
Practice Address - Street 1:566 N KIMBALL AVE STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6880
Practice Address - Country:US
Practice Address - Phone:469-955-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34032085R0202X
TXP86662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology