Provider Demographics
NPI:1083633226
Name:JOSEPH ZADEH DO
Entity Type:Organization
Organization Name:JOSEPH ZADEH DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-903-8041
Mailing Address - Street 1:1411 MCDAVID DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2845
Mailing Address - Country:US
Mailing Address - Phone:817-903-8041
Mailing Address - Fax:
Practice Address - Street 1:1411 MCDAVID DR
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2845
Practice Address - Country:US
Practice Address - Phone:817-903-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCH3326OtherRR MEDICARE GROUP #
TXP00130994OtherRR MEDICARE INDIVIDUAL #
TX00791KMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TXCH3326OtherRR MEDICARE GROUP #
TX82260NMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
TX82270NMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
TXP00130994OtherRR MEDICARE INDIVIDUAL #