MEDICARE: DR. EUGENE P HADDOCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	E0030	TX

General Provider Information

NPI Number	:	1508866880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE P HADDOCK M.D.

Provider Business Mailing Address
First Line	:	301 JUNCTION HWY
Second Line	:	SUITE 220
City	:	KERRVILLE
State	:	TX
Zip	:	78028-4247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 JUNCTION HWY
Second Line	:	SUITE 220
City	:	KERRVILLE
State	:	TX
Zip	:	78028-4247
Country	:	US
Telephone Number	:	830-896-3730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/21/2010

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