Provider Demographics
NPI:1811131758
Name:HAROLD B.EUDALY JR., M.D.PA
Entity type:Organization
Organization Name:HAROLD B.EUDALY JR., M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:B
Authorized Official - Last Name:EUDALY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:817-763-0022
Mailing Address - Street 1:6300 RIDGLEA PLACE
Mailing Address - Street 2:SUITE 814
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5704
Mailing Address - Country:US
Mailing Address - Phone:817-763-0022
Mailing Address - Fax:817-763-0027
Practice Address - Street 1:6300 RIDGLEA PL
Practice Address - Street 2:SUITE 814
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5704
Practice Address - Country:US
Practice Address - Phone:817-763-0022
Practice Address - Fax:817-763-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC69302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881792026OtherOLD NPI