Provider Demographics
NPI:1912015488
Name:SALCEDO, CHRISTOPHE C (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHE
Middle Name:C
Last Name:SALCEDO
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 1:1631 NORTH LOOP WEST #635
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1536
Mailing Address - Country:US
Mailing Address - Phone:713-880-0218
Mailing Address - Fax:713-864-3514
Practice Address - Street 1:1631 NORTH LOOP WEST #635
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1536
Practice Address - Country:US
Practice Address - Phone:713-880-0218
Practice Address - Fax:713-864-3514
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6713208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096663201Medicaid
00361KOtherMEDICARE GROUP NUMBER
G68712Medicare UPIN
TX096663201Medicaid