1891729091 NPI number — PEDRO T ZEVALLOS MD

Table of content: PEDRO T ZEVALLOS MD (NPI 1891729091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891729091 NPI number — PEDRO T ZEVALLOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEVALLOS
Provider First Name:
PEDRO
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891729091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 E INTERSTATE 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKWALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75087-5408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-551-9113
Provider Business Mailing Address Fax Number:
972-264-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8344 E.RL THORNTON FWY.
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-289-5864
Provider Business Practice Location Address Fax Number:
972-289-3130
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X , with the licence number:  E6960 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: E6960 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1225955 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613638 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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