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General NPI Number Information
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NPI Number | 1811131758
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Entity Type | Organization
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Legal Business Name | HAROLD B.EUDALY JR., M.D.PA
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 6300 RIDGLEA PL SUITE 814
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City | FORT WORTH
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State | TX
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Zip | 76116-5704
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Country | US
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Telephone | 817-763-0022
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Fax | 817-763-0027
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Provider Business Mailing Address
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Address Line | 6300 RIDGLEA PLACE SUITE 814
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City | FORT WORTH
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State | TX
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Zip | 76116-5704
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Country | US
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Telephone | 817-763-0022
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Fax | 817-763-0027
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAROLD B EUDALY JR.
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Credential | M.D.
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Telephone | 817-763-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C6930
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License Number State | TX
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