Provider Demographics
NPI:1427128255
Name:MCNALLY, EUGENE DAVID (MD MPH)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:DAVID
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 COWAN ROAD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507
Mailing Address - Country:US
Mailing Address - Phone:228-896-5195
Mailing Address - Fax:228-897-2395
Practice Address - Street 1:350 COWAN ROAD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507
Practice Address - Country:US
Practice Address - Phone:228-896-5195
Practice Address - Fax:228-897-2395
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11462208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0012671Medicaid
MS080000366Medicare ID - Type Unspecified
MS0012671Medicaid