Healthcare Provider Details

I. General information

NPI: 1275707689
Provider Name (Legal Business Name): GERARDO ZAVALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 CENTERVIEW
SAN ANTONIO TX
78228-1202
US

IV. Provider business mailing address

PO BOX 205124
DALLAS TX
75320-5724
US

V. Phone/Fax

Practice location:
  • Phone: 210-255-8935
  • Fax: 210-255-8026
Mailing address:
  • Phone: 210-255-8935
  • Fax: 210-255-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM9760
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: