Provider Demographics
NPI:1164485140
Name:SAUCEDO, JOSEPH EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110
Mailing Address - Country:US
Mailing Address - Phone:903-641-4895
Mailing Address - Fax:903-641-4894
Practice Address - Street 1:400 HOSPITAL DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110
Practice Address - Country:US
Practice Address - Phone:903-641-3830
Practice Address - Fax:903-875-1515
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84074XOtherBLUE CROSS
TX145219502Medicaid
TX8B6957Medicare PIN
TXG89501Medicare UPIN
TX145219502Medicaid