Provider Demographics
NPI:1063415925
Name:SALTER, OSCAR R (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:R
Last Name:SALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5832
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:12222 MERIT DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3294
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045309207L00000X
TXN4715207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA068641OtherANTHEM BC OF VA
VA10071OtherOPTIMA SENTARA
NC0597HOtherBC BS OF NORTH CAROLINA
NC560597HMedicaid
VA005730961Medicaid
VA050024699Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE
VA10071OtherOPTIMA SENTARA
VAE67361Medicare UPIN
NC560597HMedicaid