Provider Demographics
NPI:1659380970
Name:SALAZAR, JORGE D (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:D
Last Name:SALAZAR
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 1:6431 FANNIN ST MSB 6.264
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7339
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3004
Practice Address - Country:US
Practice Address - Phone:713-500-7339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3080208600000X, 208G00000X
MS21010208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03283037Medicaid
G44866Medicare UPIN
TX8L1699Medicare PIN
MS03283037Medicaid
MS302I784175Medicare PIN
MS302I785652Medicare PIN