1245436955 NPI number — RICHARD SALAZAR MONTERO MD

Table of content: RICHARD SALAZAR MONTERO MD (NPI 1245436955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245436955 NPI number — RICHARD SALAZAR MONTERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALAZAR MONTERO
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245436955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 PINE ST
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-240-2337
Provider Business Mailing Address Fax Number:
334-293-6859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 PINE ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-0165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-293-8082
Provider Business Practice Location Address Fax Number:
334-293-8088
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301092121 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 52158 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25484265 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: C063693 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40699510 . This is a "ID NUMBER" identifier . This identifiers is of the category "OTHER".




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