Provider Demographics
NPI:1659603850
Name:SAUCEDO CRESPO, HECTOR IVAN (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:IVAN
Last Name:SAUCEDO CRESPO
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 1:1315 S CLIFF AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1057
Mailing Address - Country:US
Mailing Address - Phone:713-569-7568
Mailing Address - Fax:
Practice Address - Street 1:1315 S CLIFF AVE STE 1100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1057
Practice Address - Country:US
Practice Address - Phone:713-569-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10031144208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery