Provider Demographics
NPI:1235354507
Name:SERGIO G. PRECIADO, M.D., P.A.
Entity Type:Organization
Organization Name:SERGIO G. PRECIADO, M.D., P.A.
Other - Org Name:PHARR KID'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRECIADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-787-2500
Mailing Address - Street 1:832 DEL ORO
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
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERGIO G. PRECIADO, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-13
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1840126Medicaid
TX8X5070OtherBCBS PROVIDER NUMBER
TX8X5070OtherBCBS PROVIDER NUMBER