Provider Demographics
NPI:1528357605
Name:JOHN C GUEDALIA MD PA
Entity Type:Organization
Organization Name:JOHN C GUEDALIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUEDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-717-4064
Mailing Address - Street 1:PO BOX 165989
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-5989
Mailing Address - Country:US
Mailing Address - Phone:972-717-4064
Mailing Address - Fax:972-717-7565
Practice Address - Street 1:3108 HIDALGO ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6529
Practice Address - Country:US
Practice Address - Phone:972-717-4064
Practice Address - Fax:972-717-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty