Provider Demographics
NPI:1003916255
Name:ZAVALA, GERARDO (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
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 1:4423 NW LOOP 410
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-541-9898
Mailing Address - Fax:210-541-0580
Practice Address - Street 1:4423 NW LOOP 410
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-541-9898
Practice Address - Fax:210-541-0580
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3011207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F1234Medicare PIN
B27795Medicare UPIN