Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD00041939 | WA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | MD204239 | OR |
NPI | 1043294291 |
---|---|
Provider Name | Tariq Salam |
First Address | Bend, OR 97701-6051 |
Second Address | Tacoma, WA 98405-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 28/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500797752 | (05) | OR |
8332439 | (05) | WA |
H79882 | (02) |