Provider Demographics
NPI:1053479998
Name:GOMEZ ZAPATA, EFRAIM (MD)
Entity type:Individual
Prefix:DR
First Name:EFRAIM
Middle Name:
Last Name:GOMEZ ZAPATA
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 1:60 STRAWBERRY HILL AVE STE L1
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8504
Mailing Address - Country:US
Mailing Address - Phone:203-327-1288
Mailing Address - Fax:203-327-1025
Practice Address - Street 1:60 STRAWBERRY HILL AVE STE L1
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8504
Practice Address - Country:US
Practice Address - Phone:203-327-1288
Practice Address - Fax:203-327-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83192Medicare UPIN