Provider Demographics
NPI:1538220892
Name:SALAZAR, HERNAN ALFONSO (DO)
Entity type:Individual
Prefix:
First Name:HERNAN
Middle Name:ALFONSO
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 WURZBACH ROAD
Mailing Address - Street 2:SUITE 1206
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4334
Mailing Address - Country:US
Mailing Address - Phone:210-614-7711
Mailing Address - Fax:
Practice Address - Street 1:8600 WURZBACH ROAD
Practice Address - Street 2:SUITE 1206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4334
Practice Address - Country:US
Practice Address - Phone:210-614-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032304002Medicaid