MEDICARE: DR. ALFRED GONZALO ZEVALLOS M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J4635	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831202514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED GONZALO ZEVALLOS M.D.

Provider Business Mailing Address
First Line	:	4510 N MACARTHUR BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6497
Country	:	US
Telephone Number	:	214-879-7800
Fax Number	:	855-576-4344

Provider Business Practice Location Address
First Line	:	4510 N MACARTHUR BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6497
Country	:	US
Telephone Number	:	214-879-7800
Fax Number	:	855-576-4344

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	11/25/2024

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