Healthcare Provider Details

I. General information

NPI: 1295789782
Provider Name (Legal Business Name): EUGENE S MACKIE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 CORNERSTONE BLVD
EDINBURG TX
78539-3475
US

IV. Provider business mailing address

2401 CORNERSTONE BLVD
EDINBURG TX
78539-3475
US

V. Phone/Fax

Practice location:
  • Phone: 956-631-2957
  • Fax: 956-631-1983
Mailing address:
  • Phone: 956-631-2957
  • Fax: 956-631-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberF8559
License Number StateTX

VIII. Authorized Official

Name: DR. EUGENE SCOTT MACKIE
Title or Position: OWNER
Credential: MD
Phone: 956-631-2957