Provider Demographics
NPI:1720090152
Name:RAFAEL SALAS MD PA
Entity Type:Organization
Organization Name:RAFAEL SALAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-766-2017
Mailing Address - Street 1:1140 LEVI
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-2059
Mailing Address - Country:US
Mailing Address - Phone:813-766-2017
Mailing Address - Fax:813-933-9585
Practice Address - Street 1:1055 CLARKSVILLE ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6097
Practice Address - Country:US
Practice Address - Phone:903-739-7830
Practice Address - Fax:903-739-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047202208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099NSOtherBLUE CROSS BLUE SHIELD
TX8F4156Medicare PIN
FLD63285Medicare UPIN