Provider Demographics
NPI:1184731523
Name:ALCANTAR, EDUARDO SALCIDO SR (MD,)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:SALCIDO
Last Name:ALCANTAR
Suffix:SR
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 1:2078 E SOUTHERN AVE STE D101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7545
Mailing Address - Country:US
Mailing Address - Phone:480-968-9890
Mailing Address - Fax:480-968-9895
Practice Address - Street 1:2078 E SOUTHERN AVE STE D101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7545
Practice Address - Country:US
Practice Address - Phone:480-968-9890
Practice Address - Fax:480-968-9895
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ277013Medicaid
AZZMD17509Medicare ID - Type Unspecified
AZ277013Medicaid