Healthcare Provider Details

I. General information

NPI: 1699011924
Provider Name (Legal Business Name): EUGENE J KOAY M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HOLCOMBE BLVD MS 97
HOUSTON TX
77030-4004
US

IV. Provider business mailing address

1220 HOLCOMBE BLVD MS 97
HOUSTON TX
77030-4004
US

V. Phone/Fax

Practice location:
  • Phone: 817-805-2839
  • Fax:
Mailing address:
  • Phone: 817-805-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberBP20038551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: