Provider Demographics
NPI:1255474797
Name:SALIB, VIOLETTE W (MD)
Entity Type:Individual
Prefix:
First Name:VIOLETTE
Middle Name:W
Last Name:SALIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2909
Mailing Address - Country:US
Mailing Address - Phone:321-267-3773
Mailing Address - Fax:
Practice Address - Street 1:CHS-005, KENNEDY SPACE CENTER
Practice Address - Street 2:
Practice Address - City:KENNEDY SPACE CENTER
Practice Address - State:FL
Practice Address - Zip Code:32899
Practice Address - Country:US
Practice Address - Phone:321-861-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL038285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine