Healthcare Provider Details

I. General information

NPI: 1336106681
Provider Name (Legal Business Name): JORGE A SALAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 NONCONNAH BLVD SUITE 120
MEMPHIS TN
38132-2113
US

IV. Provider business mailing address

1407 UNION AVE, STE 640
MEMPHIS TN
38104-3666
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8813
  • Fax: 901-302-2120
Mailing address:
  • Phone: 901-866-8375
  • Fax: 901-302-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number34499
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: