Provider Demographics
NPI:1831202514
Name:ZEVALLOS, ALFRED GONZALO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:GONZALO
Last Name:ZEVALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4510 N MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6497
Mailing Address - Country:US
Mailing Address - Phone:214-879-7800
Mailing Address - Fax:855-576-4344
Practice Address - Street 1:4510 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6497
Practice Address - Country:US
Practice Address - Phone:214-879-7800
Practice Address - Fax:855-576-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047986701Medicaid
TXG11274Medicare UPIN
TX00T72ZMedicare PIN