Provider Demographics
NPI:1043324411
Name:ZAVATSKY, ALBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:R
Last Name:ZAVATSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ACOMA-CANONCITO-LAGUNA INDIAN HOSPITAL
Mailing Address - Street 2:P.O. BOX 130
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049-0130
Mailing Address - Country:US
Mailing Address - Phone:505-552-5300
Mailing Address - Fax:
Practice Address - Street 1:ACOMA-CANONCITO-LAGUNA INDIAN HOSPITAL
Practice Address - Street 2:INTERSTATE I-40 AT EXIT 102
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049-0130
Practice Address - Country:US
Practice Address - Phone:505-552-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF80041Medicare UPIN