MEDICARE: DR. JUAN JOSE SALAZAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G6390	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003804741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN JOSE SALAZAR MD

Provider Business Mailing Address
First Line	:	PO BOX 749
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-1614
Country	:	US
Telephone Number	:	956-687-1177
Fax Number	:	956-687-3290

Provider Business Practice Location Address
First Line	:	801 E NOLANA AVE STE 2
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-6113
Country	:	US
Telephone Number	:	956-687-1177
Fax Number	:	956-687-3290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	04/19/2023

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