Healthcare Provider Details

I. General information

NPI: 1508813916
Provider Name (Legal Business Name): PABLO V UCEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BOLTON BOONE DR STE 105
DESOTO TX
75115-2041
US

IV. Provider business mailing address

2801 BOLTON BOONE DR STE 105
DESOTO TX
75115-2041
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-5165
  • Fax: 972-296-2522
Mailing address:
  • Phone: 214-946-5165
  • Fax: 972-296-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ4675
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: