Provider Demographics
NPI:1235191495
Name:SALISBURY, STEVEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:SALISBURY
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 1:1300 N 500 E
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:435-755-2100
Mailing Address - Fax:435-752-0478
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:SUITE 370
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-755-2100
Practice Address - Fax:435-752-0478
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT178107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD87621Medicare UPIN
UT0000011759Medicare ID - Type Unspecified