Provider Demographics
NPI:1235195496
Name:SALZMAN, GARY H (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:H
Last Name:SALZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 508
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2849
Mailing Address - Country:US
Mailing Address - Phone:602-839-3927
Mailing Address - Fax:602-839-4233
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-839-3927
Practice Address - Fax:602-239-4233
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23722207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ368119Medicaid
AZ368119Medicaid
C44220Medicare UPIN