Provider Demographics
NPI:1710233366
Name:SALDIVAR, MARC AARON (PA-C)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:AARON
Last Name:SALDIVAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 W SOUTH LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3968
Mailing Address - Country:US
Mailing Address - Phone:254-459-7130
Mailing Address - Fax:254-459-7148
Practice Address - Street 1:2275 W SOUTH LOOP STE 100
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3968
Practice Address - Country:US
Practice Address - Phone:254-459-7130
Practice Address - Fax:254-459-7148
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA07921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710233366Medicaid
TX294102YKN5Medicare PIN