Provider Demographics
NPI:1912965195
Name:POSNOCK, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:POSNOCK
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 1:2305 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6111
Mailing Address - Country:US
Mailing Address - Phone:817-571-6622
Mailing Address - Fax:817-868-1962
Practice Address - Street 1:2305 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6111
Practice Address - Country:US
Practice Address - Phone:817-571-6622
Practice Address - Fax:817-868-1962
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9644207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035410201Medicaid
TXD18876Medicare UPIN
TX035410201Medicaid