Provider Demographics
NPI:1336302256
Name:EDGAR ZAMBRANO D.O, P.A
Entity Type:Organization
Organization Name:EDGAR ZAMBRANO D.O, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-575-9408
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1685
Mailing Address - Country:US
Mailing Address - Phone:903-575-9408
Mailing Address - Fax:903-575-9611
Practice Address - Street 1:103 W 17TH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2301
Practice Address - Country:US
Practice Address - Phone:903-575-9408
Practice Address - Fax:903-575-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4680208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066RVOtherBLUE CROSS & BLUE SHIELD
TXDO3885OtherMEDICARE RAILROAD
TX196786101Medicaid
TX196786101Medicaid