Provider Demographics
NPI:1104976539
Name:SAUCEDO, JUAN (DO)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CROWN RIDGE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3219
Mailing Address - Country:US
Mailing Address - Phone:830-876-9458
Mailing Address - Fax:830-876-2411
Practice Address - Street 1:1000 CROWN RIDGE BLVD
Practice Address - Street 2:STE C
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3219
Practice Address - Country:US
Practice Address - Phone:830-335-2552
Practice Address - Fax:830-335-2580
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2303207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF32218Medicare UPIN
TX85M927Medicare Oscar/Certification