Healthcare Provider Details

I. General information

NPI: 1558315739
Provider Name (Legal Business Name): THOMAS A SALZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 EARL RUDDER FWY S
COLLEGE STATION TX
77845-6080
US

IV. Provider business mailing address

2800 S TEXAS AVE SUITE 102
BRYAN TX
77802-5361
US

V. Phone/Fax

Practice location:
  • Phone: 979-680-8808
  • Fax: 979-695-6517
Mailing address:
  • Phone: 979-774-2060
  • Fax: 979-776-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ5638
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberJ5638
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberJ5638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: