Provider Demographics
NPI:1881782860
Name:SALTER, SUZAN RENEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:RENEE
Last Name:SALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14493 S. PADRE ISLAND DR. STE A
Mailing Address - Street 2:#PMB296
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5939
Mailing Address - Country:US
Mailing Address - Phone:318-243-9370
Mailing Address - Fax:
Practice Address - Street 1:7121 S. PADRE ISLAND DR STE 300
Practice Address - Street 2:THOMAS SPAN CLINIC
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78912
Practice Address - Country:US
Practice Address - Phone:361-696-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04064363AM0700X
TXPA04064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8K6173Medicare UPIN