1073551511 NPI number — DANIEL SALMERON MD

Table of content: DANIEL SALMERON MD (NPI 1073551511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073551511 NPI number — DANIEL SALMERON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALMERON
Provider First Name:
DANIEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073551511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4809 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-6917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-988-8801
Provider Business Mailing Address Fax Number:
337-988-8805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14116 CUSTOMS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-5164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-957-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD.200830 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1071064 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD.200830 . This is a "MEDICAL LICESE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: P00341271 . This is a "PALMETTO GBA - RAILROAD M" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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