Provider Demographics
NPI:1720585359
Name:ZOVATH, ANDREW JOHN (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:ZOVATH
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 1:1525 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8849
Mailing Address - Country:US
Mailing Address - Phone:337-494-6767
Mailing Address - Fax:337-494-6750
Practice Address - Street 1:1525 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8849
Practice Address - Country:US
Practice Address - Phone:337-494-6767
Practice Address - Fax:337-494-6750
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8409207Q00000X
390200000X
LA312473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX425653901Medicaid
TXQ00277466OtherRAILROAD MEDICARE PTAN