Provider Demographics
NPI:1902803687
Name:PADUA, FEDERICO PASUDAG (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:PASUDAG
Last Name:PADUA
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 1:1630 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1427
Mailing Address - Country:US
Mailing Address - Phone:210-927-7930
Mailing Address - Fax:210-922-9193
Practice Address - Street 1:1630 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1427
Practice Address - Country:US
Practice Address - Phone:210-927-7930
Practice Address - Fax:210-922-9193
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127128001Medicaid
TXNK65125Medicare ID - Type Unspecified
C20125Medicare UPIN