Provider Demographics
NPI:1760464366
Name:SAADE, GUILLERMO ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ALFONSO
Last Name:SAADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ETMC
Other - Middle Name:
Other - Last Name:FIRST PHYSICIANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:203 NACOGDOCHES ST STE 290
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2444
Mailing Address - Country:US
Mailing Address - Phone:903-586-0591
Mailing Address - Fax:903-541-5687
Practice Address - Street 1:203 NACOGDOCHES ST
Practice Address - Street 2:STE 290
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2444
Practice Address - Country:US
Practice Address - Phone:903-586-0591
Practice Address - Fax:903-541-5687
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114243202Medicaid
D67710Medicare UPIN
TX114243202Medicaid