Provider Demographics
NPI:1215032602
Name:ZEPEDA, LUIS ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-1267
Mailing Address - Country:US
Mailing Address - Phone:713-702-1992
Mailing Address - Fax:713-391-8413
Practice Address - Street 1:3100 BROADWAY ST STE 104E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-2338
Practice Address - Country:US
Practice Address - Phone:713-634-0200
Practice Address - Fax:713-634-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8J9284OtherBCBS
4136869OtherBLUELINKID
8K0447OtherPTAN
8K0447OtherPTAN
4136869OtherBLUELINKID