MEDICARE: JOHN C GUEDALIA MD PA

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	207L00000X	Anesthesiology Physician	E0331	TX

General Provider Information

NPI Number	:	1528357605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C GUEDALIA MD PA

Provider Business Mailing Address
First Line	:	PO BOX 165989
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75016-5989
Country	:	US
Telephone Number	:	972-717-4064
Fax Number	:	972-717-7565

Provider Business Practice Location Address
First Line	:	3108 HIDALGO ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6529
Country	:	US
Telephone Number	:	972-717-4064
Fax Number	:	972-717-4064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN C GUEDALIA
Credential	:	MD
Telephone Number	:	972-717-4064

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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