Provider Demographics
NPI:1902013238
Name:ZAVALA, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ZAVALA
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 1:1850 POPLAR CREST CV
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4877
Mailing Address - Country:US
Mailing Address - Phone:901-300-3232
Mailing Address - Fax:901-881-1103
Practice Address - Street 1:1850 POPLAR CREST CV
Practice Address - Street 2:SUITE 105
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4877
Practice Address - Country:US
Practice Address - Phone:901-300-3232
Practice Address - Fax:901-881-1103
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD046284207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology