Provider Demographics
NPI:1558418905
Name:SALVADOR, EUGENE Q (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:Q
Last Name:SALVADOR
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:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1223
Mailing Address - Fax:505-722-1421
Practice Address - Street 1:516 EAST NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1223
Practice Address - Fax:505-722-1421
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4226207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029587501Medicaid
AZ459921Medicaid
NM21656860Medicaid
NM21656860Medicaid
NM8HK411Medicare PIN
TX029587501Medicaid