Provider Demographics
NPI:1689985665
Name:JESUS A ZAVALETA JR MD PA
Entity Type:Organization
Organization Name:JESUS A ZAVALETA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAVALETA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-687-9554
Mailing Address - Street 1:204 W NOLANA
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2513
Mailing Address - Country:US
Mailing Address - Phone:956-687-9554
Mailing Address - Fax:956-687-9556
Practice Address - Street 1:204 W NOLANA
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2513
Practice Address - Country:US
Practice Address - Phone:956-687-9554
Practice Address - Fax:956-687-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035217101Medicaid
TXB27799Medicare UPIN
TXNR63Medicare PIN