Healthcare Provider Details

I. General information

NPI: 1598805632
Provider Name (Legal Business Name): CHARLES W ZAVALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHARLES WILLIAM ZAVALA M.D.

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MORRISON RD
BROWNSVILLE TX
78526-9607
US

IV. Provider business mailing address

4401 MORRISON RD
BROWNSVILLE TX
78526-9607
US

V. Phone/Fax

Practice location:
  • Phone: 956-541-0162
  • Fax:
Mailing address:
  • Phone: 956-541-0162
  • Fax: 956-554-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberF0099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: