MEDICARE: EUGENE P PODRAZIK 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	207Y00000X	Otolaryngology Physician	6478A	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	040015424	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	310642	OTHER		BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265418834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE P PODRAZIK M.D.

Provider Business Mailing Address
First Line	:	2210 KING BLVD.
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-577-4242
Fax Number	:	307-577-0012

Provider Business Practice Location Address
First Line	:	2210 KING BLVD.
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604
Country	:	US
Telephone Number	:	307-577-4242
Fax Number	:	307-577-0012

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	06/26/2014

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Directions to “ EUGENE P PODRAZIK M.D.” Practice Location

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