Healthcare Provider Details

I. General information

NPI: 1710243340
Provider Name (Legal Business Name): BRANDON SALGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 JEFFERSON ST
MANSFIELD LA
71052-2602
US

IV. Provider business mailing address

130 JEFFERSON ST
MANSFIELD LA
71052-2602
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-2700
  • Fax: 318-872-6214
Mailing address:
  • Phone: 318-872-2700
  • Fax: 318-872-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number307846
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ4271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: