Provider Demographics
NPI:1255329637
Name:JOHN R SALZMAN MD INC
Entity Type:Organization
Organization Name:JOHN R SALZMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SALZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-432-2343
Mailing Address - Street 1:450 30TH ST
Mailing Address - Street 2:DEPT G800
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3302
Mailing Address - Country:US
Mailing Address - Phone:931-432-2343
Mailing Address - Fax:931-432-4653
Practice Address - Street 1:450 30TH ST
Practice Address - Street 2:DEPT G800
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3302
Practice Address - Country:US
Practice Address - Phone:931-432-2343
Practice Address - Fax:931-432-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG222652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G222650Medicaid
CA00G222650OtherBLUE SHIELD
CAAW889Medicare PIN
CA00G222650OtherBLUE SHIELD