Provider Demographics
NPI:1518986959
Name:ZAPATA, JUAN RAUL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:RAUL
Last Name:ZAPATA
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 1:307W UPSHUR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-2121
Mailing Address - Country:US
Mailing Address - Phone:903-845-2159
Mailing Address - Fax:903-845-5451
Practice Address - Street 1:307 W UPSHUR AVE
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-2121
Practice Address - Country:US
Practice Address - Phone:903-845-2159
Practice Address - Fax:903-845-5451
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111558606Medicaid
TX111558606Medicaid