Provider Demographics
NPI:1760453393
Name:SALAZAR, HUMBERTO E (DO)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:E
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S JOSEY LN
Mailing Address - Street 2:STE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:972-478-2442
Mailing Address - Fax:972-478-2662
Practice Address - Street 1:1005 S JOSEY LN
Practice Address - Street 2:STE 202
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:972-478-2442
Practice Address - Fax:972-478-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00143QMedicare ID - Type Unspecified
H36001Medicare UPIN