Provider Demographics
NPI:1073796512
Name:SANTIAGO A ZAMORA MD PA
Entity Type:Organization
Organization Name:SANTIAGO A ZAMORA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-473-4180
Mailing Address - Street 1:2121 E 6TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3492
Mailing Address - Country:US
Mailing Address - Phone:512-473-4180
Mailing Address - Fax:512-469-6058
Practice Address - Street 1:2121 E 6TH ST
Practice Address - Street 2:STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3492
Practice Address - Country:US
Practice Address - Phone:512-473-4180
Practice Address - Fax:512-469-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27774Medicare UPIN
TX00422KMedicare Oscar/Certification