Provider Demographics
NPI:1720242480
Name:GARRIDO-ZAMBRANO, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:GARRIDO-ZAMBRANO
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 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-924-6210
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:252 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5153
Practice Address - Country:US
Practice Address - Phone:865-980-5200
Practice Address - Fax:865-980-5201
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130699207Q00000X
IN11014175A207Q00000X
TN62998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130699Medicaid
IL370966854004Medicaid
IL370966854002Medicaid
ILCF3444OtherMEDICARE RR
TNQ067710Medicaid
IL370966854005Medicaid
IL141848Medicare Oscar/Certification
IL141840Medicare Oscar/Certification
IL370966854005Medicaid
IL640701Medicare Oscar/Certification