MEDICARE: DR. JOHN E GUGGEDAHL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	F-4031	TX

General Provider Information

NPI Number	:	1073582904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E GUGGEDAHL M.D.

Provider Business Mailing Address
First Line	:	6955 N MESA ST
Second Line	:	#104
City	:	EL PASO
State	:	TX
Zip	:	79912-4424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6955 N MESA ST
Second Line	:	#104
City	:	EL PASO
State	:	TX
Zip	:	79912-4424
Country	:	US
Telephone Number	:	915-833-8996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/20/2007

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