Provider Demographics
NPI:1467412189
Name:ZAMORA, SERGIO (DO)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 EL INDIO HWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6615
Mailing Address - Country:US
Mailing Address - Phone:830-757-3900
Mailing Address - Fax:830-757-3838
Practice Address - Street 1:2450 EL INDIO HWY
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6615
Practice Address - Country:US
Practice Address - Phone:830-757-3900
Practice Address - Fax:830-757-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137895204Medicaid
TX137895204Medicaid
TX0091BJMedicare ID - Type Unspecified