Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS5538 | FL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS 5538 | FL |
NPI | 1477548964 |
---|---|
Provider Name | Dr. Kenneth Jeffrey Saluck |
First Address | Daytona Beach, FL 32120-9671 |
Second Address | Palm Bay, FL 32905-4610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102509900 | (05) | FL |
80348 | BCBS (01) | FL |
E59555 | (02) |