Provider Demographics
NPI:1508813916
Name:UCEDA, PABLO V (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:V
Last Name:UCEDA
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 1:221 W. COLORADO BLVD, STE 625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-946-5165
Mailing Address - Fax:214-946-4876
Practice Address - Street 1:221 W. COLORADO BLVD, STE 625
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-946-5165
Practice Address - Fax:214-946-4876
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4675208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020041464OtherRR-MEDICARE
TX118128104Medicaid
TX118128101Medicaid