Provider Demographics
NPI:1467560441
Name:SALAZAR-TIER, MARYRUTH GARCIA (MD)
Entity Type:Individual
Prefix:
First Name:MARYRUTH
Middle Name:GARCIA
Last Name:SALAZAR-TIER
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 1:301 RIVER STREET
Mailing Address - Street 2:PO BOX 218
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020
Mailing Address - Country:US
Mailing Address - Phone:715-294-2116
Mailing Address - Fax:715-294-2943
Practice Address - Street 1:301 RIVER STREET
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020
Practice Address - Country:US
Practice Address - Phone:715-294-2116
Practice Address - Fax:715-294-2943
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42789207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34024700Medicaid
WI42789OtherMEDICAL LICENSE
WIF09684Medicare UPIN