Provider Demographics
NPI:1750347084
Name:EUBANK, CHARLES DALE JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DALE
Last Name:EUBANK
Suffix:JR
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: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:361-288-2222
Mailing Address - Fax:361-884-2919
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:STE 110
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
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3940207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104959503Medicaid
TX8394B9Medicare ID - Type Unspecified
TX104959503Medicaid