MEDICARE: CARL LEE ZAMORA CRNA

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	578697	TX
2	367500000X	Certified Registered Nurse Anesthetist	578697	WI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00137889	OTHER	TX	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	84610U	OTHER	TX	BLUE CROSS BLUE SHIELD
3	047390	OTHER	TX	RECERTIFICATION AANA
4	465552276	OTHER	TX	TRICARE INSURANCE

NPI Number	:	1679568976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL LEE ZAMORA CRNA

Provider Business Mailing Address
First Line	:	PO BOX 4346
Second Line	:	DEPT 693
City	:	HOUSTON
State	:	TX
Zip	:	77210-4346
Country	:	US
Telephone Number	:	281-358-8114
Fax Number	:	281-358-0609

Provider Business Practice Location Address
First Line	:	6801 EMMETT F LOWRY EXPY
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2500
Country	:	US
Telephone Number	:	409-938-5361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	11/10/2025

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: