Provider Demographics
NPI:1265983282
Name:ROBERT G. SALAZAR M.D. INC
Entity type:Organization
Organization Name:ROBERT G. SALAZAR M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-432-6807
Mailing Address - Street 1:PO BOX 3506
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93650-3506
Mailing Address - Country:US
Mailing Address - Phone:559-432-6807
Mailing Address - Fax:559-436-6259
Practice Address - Street 1:7152 N SHARON AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3361
Practice Address - Country:US
Practice Address - Phone:559-432-6807
Practice Address - Fax:559-436-6259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT G. SALAZAR, M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42244OtherMEDICAL LICENSE