Healthcare Provider Details

I. General information

NPI: 1467194787
Provider Name (Legal Business Name): ROBERTO ZEVALLOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 200
KLAMATH FALLS OR
97601-1130
US

IV. Provider business mailing address

2865 DAGGETT AVE FL 4
KLAMATH FALLS OR
97601-1106
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-8400
  • Fax:
Mailing address:
  • Phone: 541-274-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD227180
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: