Provider Demographics
NPI:1407822281
Name:ZAMUDIO, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:ZAMUDIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:BLDG 5A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4672
Mailing Address - Country:US
Mailing Address - Phone:915-545-1200
Mailing Address - Fax:915-545-1363
Practice Address - Street 1:1201 E SCHUSTER AVE
Practice Address - Street 2:BLDG 5A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4672
Practice Address - Country:US
Practice Address - Phone:915-545-1200
Practice Address - Fax:915-545-1363
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100208101Medicaid
TX00U67WMedicare ID - Type Unspecified
TXG08147Medicare UPIN