Provider Demographics
NPI:1720260813
Name:SERGIO SANCHEZ ZAMBRANO, MD, PA
Entity Type:Organization
Organization Name:SERGIO SANCHEZ ZAMBRANO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PA
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ ZAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-558-4403
Mailing Address - Street 1:811 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-3816
Mailing Address - Country:US
Mailing Address - Phone:817-558-4403
Mailing Address - Fax:817-641-3272
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-558-4403
Practice Address - Fax:817-641-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27770Medicare UPIN
TX00L27YMedicare PIN