Basic Information
| Provider Information | |||||||||
| NPI: | 1043324411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAVATSKY | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ACOMA-CANONCITO-LAGUNA INDIAN HOSPITAL | ||||||||
| Address2: | P.O. BOX 130 | ||||||||
| City: | SAN FIDEL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870490130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055525300 | ||||||||
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| Practice Location | |||||||||
| Address1: | ACOMA-CANONCITO-LAGUNA INDIAN HOSPITAL | ||||||||
| Address2: | INTERSTATE I-40 AT EXIT 102 | ||||||||
| City: | SAN FIDEL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870490130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055525200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11015 | MT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.