Provider Demographics
NPI:1003804741
Name:SALAZAR, JUAN JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOSE
Last Name:SALAZAR
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-687-1177
Mailing Address - Fax:956-687-3290
Practice Address - Street 1:801 E NOLANA AVE STE 2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6113
Practice Address - Country:US
Practice Address - Phone:956-687-1177
Practice Address - Fax:956-687-3290
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128090105Medicaid
C21480Medicare UPIN
00E442Medicare ID - Type Unspecified