Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G6390 | TX |
Y | 111NI0900X | Internist | G6390 | TX |
NPI | 1003804741 |
---|---|
Provider Name | Mr. Juan Jose Salazar |
First Address | Mcallen, TX 78504 |
Second Address | Mcallen, TX 78504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 30/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128090105 | (05) | TX |
C21480 | (02) |