Provider Demographics
NPI:1003898628
Name:BAYLAN, SALVADOR P (MD)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:P
Last Name:BAYLAN
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 1:4202 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1864
Mailing Address - Country:US
Mailing Address - Phone:210-731-4100
Mailing Address - Fax:210-731-4123
Practice Address - Street 1:4202 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1864
Practice Address - Country:US
Practice Address - Phone:210-731-4100
Practice Address - Fax:210-731-4123
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123610104Medicaid
742210920OtherUNITED HEALTHCARE
TX176694100OtherDEPARTMENT OF LABOR
TX0085478801Medicaid
100299461920OtherHUMANA
2313281OtherBLUELINK
TX250003126OtherRAILROAD MEDICARE
C12381Medicare UPIN
TX123610104Medicaid