Provider Demographics
NPI:1912939828
Name:SALAZAR, ROBERT E (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0247
Mailing Address - Country:US
Mailing Address - Phone:435-654-1501
Mailing Address - Fax:435-654-2030
Practice Address - Street 1:35 S 500 E
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1918
Practice Address - Country:US
Practice Address - Phone:435-654-1501
Practice Address - Fax:435-654-2030
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT343311-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS52274Medicare UPIN
UT005552901Medicare ID - Type UnspecifiedMEDICARE