Provider Demographics
NPI:1952328866
Name:ZUNIGA GOLDWATER, ADONIS (MD)
Entity Type:Individual
Prefix:
First Name:ADONIS
Middle Name:
Last Name:ZUNIGA GOLDWATER
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:PO BOX 451427
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0035
Mailing Address - Country:US
Mailing Address - Phone:956-726-0647
Mailing Address - Fax:956-725-1575
Practice Address - Street 1:2412 JACAMAN RD
Practice Address - Street 2:STE103
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6229
Practice Address - Country:US
Practice Address - Phone:956-726-0647
Practice Address - Fax:956-725-1575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80075741OtherDPS
TXH8557OtherLICENSE
TX7942BOtherECFMG
TX136773209Medicaid
TX136773209Medicaid
TXH8557OtherLICENSE
TX136773209Medicaid