Provider Demographics
NPI:1396776167
Name:ZAMORA, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:ZAMORA
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 1:4302 S SUGAR RD
Mailing Address - Street 2:STE 106
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9140
Mailing Address - Country:US
Mailing Address - Phone:361-389-4034
Mailing Address - Fax:956-546-3406
Practice Address - Street 1:307 N D SALINAS AVE STE D
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2929
Practice Address - Country:US
Practice Address - Phone:956-464-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TXG6427207P00000X, 208600000X, 2086S0129X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130555907Medicaid
TX164541801Medicaid
TXG6427Medicare UPIN
TX8B5504Medicare PIN
TX130555907Medicaid