Provider Demographics
NPI:1619931433
Name:ZEVALLOS, CARLOS E JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:ZEVALLOS
Suffix:JR
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 1:471 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2426
Mailing Address - Country:US
Mailing Address - Phone:330-668-4045
Mailing Address - Fax:330-668-2492
Practice Address - Street 1:471 N CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2426
Practice Address - Country:US
Practice Address - Phone:330-668-4045
Practice Address - Fax:330-668-2492
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008130207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00337252OtherMEDICARE ID
OH2667261Medicaid
OH2667261Medicaid
OHP00337252OtherMEDICARE ID