Provider Demographics
NPI:1891729091
Name:ZEVALLOS, PEDRO T (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:T
Last Name:ZEVALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:519 E INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5408
Mailing Address - Country:US
Mailing Address - Phone:972-551-9113
Mailing Address - Fax:972-264-2333
Practice Address - Street 1:8344 E.RL THORNTON FWY.
Practice Address - Street 2:SUITE 420
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228
Practice Address - Country:US
Practice Address - Phone:972-289-5864
Practice Address - Fax:972-289-3130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE69602080P0214X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225955Medicaid
TX613638OtherMEDICARE NUMBER