Provider Demographics
NPI:1821089418
Name:SALAZAR, BERETTE ANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:BERETTE
Middle Name:ANNE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BERETTE
Other - Middle Name:ANNE
Other - Last Name:AMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7750 CLAYTON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1353
Mailing Address - Country:US
Mailing Address - Phone:314-781-9299
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON RD
Practice Address - Street 2:STE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1353
Practice Address - Country:US
Practice Address - Phone:314-781-9299
Practice Address - Fax:314-961-1686
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8P652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000002551Medicare ID - Type Unspecified
E32564Medicare UPIN