Provider Demographics
NPI:1730199811
Name:IBARGUEN-SECCHIA, EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:IBARGUEN-SECCHIA
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 1:4410 MEDICAL DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6306
Mailing Address - Country:US
Mailing Address - Phone:210-575-6240
Mailing Address - Fax:210-575-6280
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6306
Practice Address - Country:US
Practice Address - Phone:210-575-6240
Practice Address - Fax:210-575-6280
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH55722080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120189907 TRADMedicaid
TX120189908 CSNMedicaid
TX8EA036OtherBCBS
TX120189907 TRADMedicaid