Provider Demographics
NPI:1023074887
Name:C. DALE EUBANK, M.D., P.A.
Entity type:Organization
Organization Name:C. DALE EUBANK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:EUBANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-906-1277
Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:361-371-8376
Practice Address - Street 1:5920 SARATOGA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4104
Practice Address - Country:US
Practice Address - Phone:361-906-1277
Practice Address - Fax:361-906-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3940207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153996702Medicaid
TX153996702Medicaid
TX00103UMedicare ID - Type Unspecified
TX8394B9Medicare PIN