Provider Demographics
NPI:1164485140
Name:SAUCEDO, JOSEPH EDWARD (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W 2ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3780
Mailing Address - Country:US
Mailing Address - Phone:903-641-7943
Mailing Address - Fax:844-299-0002
Practice Address - Street 1:1115 W 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3780
Practice Address - Country:US
Practice Address - Phone:903-641-7943
Practice Address - Fax:844-299-0002
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84074XOtherBLUE CROSS
TX145219502Medicaid
TX8B6957Medicare PIN
TXG89501Medicare UPIN
TX145219502Medicaid