Healthcare Provider Details

I. General information

NPI: 1689680944
Provider Name (Legal Business Name): THOMAS P ZAVALETA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 JEFFERSON ST STE A
AUSTIN TX
78731-6206
US

IV. Provider business mailing address

3708 JEFFERSON ST STE A
AUSTIN TX
78731-6206
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-6503
  • Fax: 512-454-7453
Mailing address:
  • Phone: 512-459-6503
  • Fax: 512-454-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE2961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: