Provider Demographics
NPI:1235152570
Name:SAHADI, JACK A (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:A
Last Name:SAHADI
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 1:900 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2028
Mailing Address - Country:US
Mailing Address - Phone:361-888-4288
Mailing Address - Fax:381-888-4786
Practice Address - Street 1:900 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2028
Practice Address - Country:US
Practice Address - Phone:361-888-4288
Practice Address - Fax:381-888-4786
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00M003OtherBLUE CROSS/BLUE SHIELD
8W8770OtherBLUE CROSS/BLUE SHIELD
00M003Medicare PIN
TX8K3343Medicare PIN
TXB26105Medicare UPIN