Provider Demographics
NPI:1316968860
Name:PACE, EUGENE H (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:H
Last Name:PACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 RIVER BEND DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4915
Mailing Address - Country:US
Mailing Address - Phone:214-638-2000
Mailing Address - Fax:214-631-6724
Practice Address - Street 1:1500 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:214-638-2000
Practice Address - Fax:214-631-6724
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1501207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124830406Medicaid
TX8S9692OtherBCBS
TX8D9444Medicare ID - Type UnspecifiedLOCALITY 28
B48872Medicare UPIN