Provider Demographics
NPI:1760431845
Name:WYSZYNSKI, EUGENE JONATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JONATHAN
Last Name:WYSZYNSKI
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 1:12700 HILLCREST RD
Mailing Address - Street 2:STE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2033
Mailing Address - Country:US
Mailing Address - Phone:469-453-5500
Mailing Address - Fax:972-243-1285
Practice Address - Street 1:12700 HILLCREST RD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2055
Practice Address - Country:US
Practice Address - Phone:469-453-5500
Practice Address - Fax:972-243-1285
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3941207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
452914ZQAKOtherMEDICARE PTAN
TX115286014Medicaid
TX115286007Medicaid
TX115286008Medicaid
TX115286009Medicaid
TX115286010Medicaid
TXTXB123276Medicare PIN
TX115286010Medicaid
TX115286007Medicaid
830004465Medicare PIN
TX8L10911Medicare PIN
TXB33569Medicare UPIN
TX115286008Medicaid
TX8L10898Medicare PIN