Provider Demographics
NPI:1396861720
Name:JAIME A. SUED MDPA
Entity Type:Organization
Organization Name:JAIME A. SUED MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-795-8393
Mailing Address - Street 1:PO BOX 450708
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0017
Mailing Address - Country:US
Mailing Address - Phone:956-795-8393
Mailing Address - Fax:956-795-8396
Practice Address - Street 1:7614 ROCIO DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6550
Practice Address - Country:US
Practice Address - Phone:956-795-8393
Practice Address - Fax:956-795-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7108207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173626601Medicaid
TX00213XMedicare ID - Type Unspecified
TX173626601Medicaid