Provider Demographics
NPI:1457550261
Name:MARIO R. SALAZAR, M.D., P.A.
Entity type:Organization
Organization Name:MARIO R. SALAZAR, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:REY
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-4458
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75120-0301
Mailing Address - Country:US
Mailing Address - Phone:972-296-4458
Mailing Address - Fax:972-875-5121
Practice Address - Street 1:7979 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3798
Practice Address - Country:US
Practice Address - Phone:972-296-4458
Practice Address - Fax:972-875-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7587208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012QCOtherBCBS
TX0012QCOtherBCBS