=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396861720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAIME A. SUED MDPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7614 ROCIO DR
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-6550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-795-8393
-----------------------------------------------------
Fax | 956-795-8396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 450708
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78045-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-795-8393
-----------------------------------------------------
Fax | 956-795-8396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. NORMA CANNO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-795-8393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | K7108
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | K7108
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------