Active NPI
Eulogio Bonsukan, MD
- Emergency Medicine Physician
- Kilgore, TX
National Provider Identifier
1285680835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- E9119
- Practice address
- 1612 S Henderson Blvd
Kilgore, TX 75662-3518 - Phone
- (903) 984-3505
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | E9119 | TX | Primary |
Addresses
Primary practice location
1612 S Henderson Blvd
Kilgore, TX 75662-3518
Mailing address
PO Box 8549
Fort Worth, TX 76124-0549
Phone (817) 451-4208
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0028EW | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201824000000",
"number": "1285680835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8549",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761240549",
"telephone_number": "817-451-4208",
"fax_number": "817-563-3699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1612 S HENDERSON BLVD",
"city": "KILGORE",
"state": "TX",
"postal_code": "756623518",
"telephone_number": "903-984-3505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONSUKAN",
"first_name": "EULOGIO",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2008-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "E9119",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0028EW",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kilgore, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.