Provider Demographics
NPI:1205636370
Name:SALAZAR, DAVID RUSSELL (AGPCNP-BC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RUSSELL
Last Name:SALAZAR
Suffix:
Gender:
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29629 ELKHORN RDG
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5104
Mailing Address - Country:US
Mailing Address - Phone:210-793-3120
Mailing Address - Fax:
Practice Address - Street 1:10300 HERITAGE ST STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3962
Practice Address - Country:US
Practice Address - Phone:210-375-4911
Practice Address - Fax:210-855-5189
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1750035242208D00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice