Basic Information
| Provider Information | |||||||||
| NPI: | 1164485140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUCEDO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 HOSPITAL DRIVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414895 | ||||||||
| FaxNumber: | 9036414894 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 HOSPITAL DRIVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036413830 | ||||||||
| FaxNumber: | 9038751515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K8473 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 84074X | 01 | TX | BLUE CROSS | OTHER | 145219502 | 05 | TX | MEDICAID |