Provider Demographics
NPI:1538153465
Name:SALAZAR, WILLIAM R (MD CH)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MD CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5052
Mailing Address - Country:US
Mailing Address - Phone:941-764-8550
Mailing Address - Fax:941-764-8338
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:STE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-764-8550
Practice Address - Fax:941-764-8338
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254947600Medicaid
FL43876OtherBCBS
FL43876ZMedicare PIN
FL254947600Medicaid
FLP00174565Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLH58502Medicare UPIN