Provider Demographics
NPI:1770594764
Name:ZAMORA, BELDA (MD)
Entity type:Individual
Prefix:
First Name:BELDA
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E 6TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724
Mailing Address - Country:US
Mailing Address - Phone:512-474-7824
Mailing Address - Fax:512-474-1068
Practice Address - Street 1:2100 E 6TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724
Practice Address - Country:US
Practice Address - Phone:512-474-7824
Practice Address - Fax:512-474-1068
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10121710102Medicaid
TX10121710102Medicaid
TX00137NMedicare ID - Type Unspecified