Provider Demographics
NPI:1750465514
Name:SANCHIRICO, PAUL J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:SANCHIRICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5130 GATEWAY BLVD E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1608
Mailing Address - Country:US
Mailing Address - Phone:915-215-4480
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-215-6000
Practice Address - Fax:915-545-6607
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM94892085R0202X, 2085R0204X
TXU68952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807399100Medicaid
ID000010156519OtherREGENCE BS OF IDAHO
WA0206650OtherLABOR & INDUSTRIES
WA8447179Medicaid
P00301368OtherRAILROAD MEDICARE
ID76573OtherBLUE CROSS OF IDAHO
WA0206650OtherLABOR & INDUSTRIES