Healthcare Provider Details

I. General information

NPI: 1043324411
Provider Name (Legal Business Name): ALBERT R. ZAVATSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ACOMA-CANONCITO-LAGUNA INDIAN HOSPITAL INTERSTATE I-40 AT EXIT 102
SAN FIDEL NM
87049-0130
US

IV. Provider business mailing address

ACOMA-CANONCITO-LAGUNA INDIAN HOSPITAL P.O. BOX 130
SAN FIDEL NM
87049-0130
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5200
  • Fax:
Mailing address:
  • Phone: 505-552-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11015
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: