Provider Demographics
NPI:1457466724
Name:TAPIA ZEGARRA, GINO GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:GUILLERMO
Last Name:TAPIA ZEGARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8042 WURZBACH RD STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3863
Mailing Address - Country:US
Mailing Address - Phone:210-614-8100
Mailing Address - Fax:210-615-7233
Practice Address - Street 1:8715 VILLAGE DR STE 514
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5407
Practice Address - Country:US
Practice Address - Phone:210-370-9922
Practice Address - Fax:210-545-5616
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND11067207RI0200X
MN102616207RI0200X
MN49064207RI0200X
MI4301079651207RI0200X
TXS4064207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN853183000Medicaid
MN853183000Medicaid