Provider Demographics
NPI:1780718767
Name:ZAMBRANO, EDGAR (DO)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:ZAMBRANO
Suffix:
Gender:M
Credentials:DO
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 1685
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-1685
Mailing Address - Country:US
Mailing Address - Phone:903-575-9408
Mailing Address - Fax:
Practice Address - Street 1:2015 MULBERRY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2312
Practice Address - Country:US
Practice Address - Phone:903-575-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4680208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191068902Medicaid
TXP00676257OtherMEDICARE RAILROAD
TX8BS780OtherBLUE CROSS & BLUE SHIELD
TX8BS780OtherBLUE CROSS & BLUE SHIELD