Provider Demographics
NPI:1114986395
Name:SALTER, CAROLYN F (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:F
Last Name:SALTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5041
Mailing Address - Country:US
Mailing Address - Phone:903-729-8328
Mailing Address - Fax:903-729-5640
Practice Address - Street 1:1021 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5041
Practice Address - Country:US
Practice Address - Phone:903-729-8328
Practice Address - Fax:903-729-5640
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85090JMedicare PIN
TXE12591Medicare UPIN