Provider Demographics
NPI:1336199694
Name:PRECIADO, SERGIO GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:GUSTAVO
Last Name:PRECIADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:832 DEL ORO LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2200
Mailing Address - Country:US
Mailing Address - Phone:956-787-2500
Mailing Address - Fax:956-787-2528
Practice Address - Street 1:832 DEL ORO LN
Practice Address - Street 2:SUITE 2
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2200
Practice Address - Country:US
Practice Address - Phone:956-787-2500
Practice Address - Fax:956-787-2528
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1347262-14Medicaid
TX1347262-15Medicaid
TX1347262-13Medicaid
TX1347262-15Medicaid