Provider Demographics
NPI:1770589384
Name:ZARATE, RUDOLFO PEDRAZA JR (MD)
Entity type:Individual
Prefix:DR
First Name:RUDOLFO
Middle Name:PEDRAZA
Last Name:ZARATE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24014 GRAN PALACIO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2766
Mailing Address - Country:US
Mailing Address - Phone:210-587-8787
Mailing Address - Fax:210-388-0239
Practice Address - Street 1:1200 BROOKLYN AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4810
Practice Address - Country:US
Practice Address - Phone:210-587-8787
Practice Address - Fax:210-388-0239
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-6383207R00000X
TXM1514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2287994Medicaid
TX1791261-01Medicaid
OHZA 4057492Medicare ID - Type UnspecifiedINDIVIDUAL
TX1791261-01Medicaid
TX8G4583Medicare ID - Type Unspecified