Provider Demographics
NPI:1417026261
Name:ZEVALLOS, ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:ZEVALLOS
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 1:5939 HARRY HINES
Mailing Address - Street 2:945
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6243
Mailing Address - Country:US
Mailing Address - Phone:214-630-2892
Mailing Address - Fax:214-879-3507
Practice Address - Street 1:5939 HARRY HINES
Practice Address - Street 2:945
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6243
Practice Address - Country:US
Practice Address - Phone:214-630-2892
Practice Address - Fax:214-879-3507
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27831Medicare UPIN
00T737Medicare ID - Type Unspecified