Provider Demographics
NPI:1013064880
Name:SALAZAR, DORA LINDA (MD)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:LINDA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 NORTHLAND DR.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4955
Mailing Address - Country:US
Mailing Address - Phone:512-476-0275
Mailing Address - Fax:512-476-0284
Practice Address - Street 1:3303 NORTHLAND DR.
Practice Address - Street 2:SUITE 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4955
Practice Address - Country:US
Practice Address - Phone:512-476-0275
Practice Address - Fax:512-476-0284
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1340986-06Medicaid
TX742688030OtherFEDERAL TAX NUMBER
TXE79914Medicare UPIN
TX00L30MMedicare ID - Type Unspecified