Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD021873E | PA |
NPI | 1508803453 |
---|---|
Provider Name | Dr. Albert Simbul Salvador |
First Address | Philadelphia, PA 19148-3213 |
Second Address | Philadelphia, PA 19148-3213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00008951420008 | (05) | PA |
0008951420009 | (05) | PW |