Provider Demographics
NPI:1558315739
Name:SALZER, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:SALZER
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 1:2800 S TEXAS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:979-774-2060
Mailing Address - Fax:979-776-5914
Practice Address - Street 1:2805 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6080
Practice Address - Country:US
Practice Address - Phone:979-680-8808
Practice Address - Fax:979-695-6517
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5638174400000X, 207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126523312Medicaid
TX0081BDMedicare ID - Type UnspecifiedMEDICARE GROUP
TX80740FMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
TXG01268Medicare UPIN
TX081199401Medicaid
TX12652303Medicaid