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General NPI Number Information
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NPI Number | 1114455375
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Entity Type | Organization
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Legal Business Name | DFMED ZAVALLA LLC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 153 BARGE RD
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City | ZAVALLA
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State | TX
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Zip | 75980-3003
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Country | US
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Telephone | 936-897-1002
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Fax | 936-647-1041
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Provider Business Mailing Address
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Address Line | PO BOX 594
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City | ZAVALLA
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State | TX
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Zip | 75980
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Country | US
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Telephone | 936-897-1002
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Fax | 936-647-1041
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROBERT YOUNG JR.
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Credential | PA-C
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Telephone | 936-897-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03871
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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