Provider Demographics
NPI:1285676775
Name:SALYER, RENA DELL (DO)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:DELL
Last Name:SALYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 ROSEMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7904
Mailing Address - Country:US
Mailing Address - Phone:313-303-1946
Mailing Address - Fax:866-891-8274
Practice Address - Street 1:2201 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:313-303-1946
Practice Address - Fax:866-891-8274
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3435207P00000X
KY03576207P00000X
MI5101017926207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI24229Medicare UPIN
TN3898438Medicare ID - Type Unspecified