Provider Demographics
NPI:1083881486
Name:SALK, PETER LINDSAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LINDSAY
Last Name:SALK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7459 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5212
Mailing Address - Country:US
Mailing Address - Phone:858-459-5935
Mailing Address - Fax:
Practice Address - Street 1:7459 HIGH AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5212
Practice Address - Country:US
Practice Address - Phone:858-459-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21860207R00000X
OH35.032356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine