Provider Demographics
NPI:1457369316
Name:DR EUGENE DIVITA
Entity type:Organization
Organization Name:DR EUGENE DIVITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIVITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-869-4110
Mailing Address - Street 1:520 POST OAK BLVD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-869-4110
Mailing Address - Fax:713-621-7758
Practice Address - Street 1:520 POST OAK BLVD
Practice Address - Street 2:SUITE 390
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-869-4110
Practice Address - Fax:713-621-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC72042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GA06Medicare ID - Type Unspecified
D8449Medicare UPIN