Provider Demographics
NPI:1174627228
Name:SALACH, RODERICK HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:HENRY
Last Name:SALACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 FORTENBERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952
Mailing Address - Country:US
Mailing Address - Phone:321-453-0779
Mailing Address - Fax:321-453-4188
Practice Address - Street 1:40 FORTENBERRY ROAD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952
Practice Address - Country:US
Practice Address - Phone:321-453-0779
Practice Address - Fax:321-453-4188
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6549207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11214Medicare UPIN