Individual
DR. IVAN V. ZAMORA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 S ARCHUSA AVE, QUITMAN, MS 39355-2325
(601) 776-2123
(601) 776-6006
Mailing address
PO BOX 5166, MERIDIAN, MS 39302-5166
(601) 703-9506
(601) 703-3264
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
08282
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
730-07886
BLUE CROSS OF AL
—
Enumeration date
11/20/2005
Last updated
07/08/2007
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