Provider Demographics
NPI:1639175961
Name:QUAICOE, SANNICHIE ARKHURST (MD)
Entity Type:Individual
Prefix:DR
First Name:SANNICHIE
Middle Name:ARKHURST
Last Name:QUAICOE
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 1:1406 S BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6674
Mailing Address - Country:US
Mailing Address - Phone:956-583-4880
Mailing Address - Fax:956-583-5280
Practice Address - Street 1:1406 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6674
Practice Address - Country:US
Practice Address - Phone:956-583-4880
Practice Address - Fax:956-583-5280
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-11-15
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
TXK1904208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018DROtherBLUE CROSS & BLUE SHIELD
TX1133456Medicaid
TX0018DROtherBLUE CROSS & BLUE SHIELD
TX1133456Medicaid