Provider Demographics
NPI:1114455375
Name:DFMED ZAVALLA LLC
Entity type:Organization
Organization Name:DFMED ZAVALLA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:936-897-1002
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:ZAVALLA
Mailing Address - State:TX
Mailing Address - Zip Code:75980
Mailing Address - Country:US
Mailing Address - Phone:936-897-1002
Mailing Address - Fax:936-647-1041
Practice Address - Street 1:153 BARGE RD
Practice Address - Street 2:
Practice Address - City:ZAVALLA
Practice Address - State:TX
Practice Address - Zip Code:75980-3003
Practice Address - Country:US
Practice Address - Phone:936-897-1002
Practice Address - Fax:936-647-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03871363A00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty