Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 47058 | AZ |
Y | 208600000X | Surgeon | 47058 | AZ |
N | 2086S0102X | Surgical Critical Care | 47058 | AZ |
N | 2086S0127X | Trauma Surgeon | 47058 | AZ |
NPI | 1093897506 |
---|---|
Provider Name | Dr. Jeffrey P Salomone |
First Address | Mesa, AZ 85202-4742 |
Second Address | Mesa, AZ 85202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 14/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
349220 | (05) | AZ |
F77081 | (02) | GA |