Provider Demographics
NPI:1841297397
Name:ZAMORA, SALVADOR (MD)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 MORGAN AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1996
Mailing Address - Country:US
Mailing Address - Phone:361-883-8058
Mailing Address - Fax:361-881-1417
Practice Address - Street 1:2222 MORGAN AVE
Practice Address - Street 2:STE 112
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1996
Practice Address - Country:US
Practice Address - Phone:361-883-8058
Practice Address - Fax:361-881-1417
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6182208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110294904Medicaid
TX800609Medicare ID - Type Unspecified
TX110294904Medicaid