Provider Demographics
NPI:1316098429
Name:OGROD, EUGENE STANLEY (MD,)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:STANLEY
Last Name:OGROD
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 1:526 KINGWOOD DR # 419
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4473
Mailing Address - Country:US
Mailing Address - Phone:916-471-8303
Mailing Address - Fax:
Practice Address - Street 1:526 KINGWOOD DR # 419
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4473
Practice Address - Country:US
Practice Address - Phone:916-471-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20999OtherCA LICENSE
CAG20999OtherCA LICENSE
A89335Medicare UPIN