Provider Demographics
NPI:1265418834
Name:PODRAZIK, EUGENE P (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
Last Name:PODRAZIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 KING BLVD.
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604
Mailing Address - Country:US
Mailing Address - Phone:307-577-4242
Mailing Address - Fax:307-577-0012
Practice Address - Street 1:2210 KING BLVD.
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604
Practice Address - Country:US
Practice Address - Phone:307-577-4242
Practice Address - Fax:307-577-0012
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6478A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
310642OtherBLUE CROSS BLUE SHIELD
040015424OtherRAILROAD MEDICARE
WY115763900Medicaid
F46678Medicare UPIN
WY308584Medicare ID - Type Unspecified