Healthcare Provider Details

I. General information

NPI: 1518986959
Provider Name (Legal Business Name): JUAN RAUL ZAPATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W UPSHUR AVE
GLADEWATER TX
75647-2121
US

IV. Provider business mailing address

307W UPSHUR AVE
GLADEWATER TX
75647-2121
US

V. Phone/Fax

Practice location:
  • Phone: 903-845-2159
  • Fax: 903-845-5451
Mailing address:
  • Phone: 903-845-2159
  • Fax: 903-845-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD9919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: