Provider Demographics
NPI:1902131923
Name:JOHN E GUGGEDAHL MD,PA
Entity Type:Organization
Organization Name:JOHN E GUGGEDAHL MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUGGEDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-833-8996
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:
Practice Address - Street 1:6955 N MESA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:915-833-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty