Provider Demographics
NPI:1093975047
Name:SALK, DARRELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:J
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 1:8933 SW LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-9104
Mailing Address - Country:US
Mailing Address - Phone:206-524-9754
Mailing Address - Fax:
Practice Address - Street 1:8933 SW LANCELOT LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-9104
Practice Address - Country:US
Practice Address - Phone:206-524-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00014658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist