Provider Demographics
NPI:1336116573
Name:SALIBA, SAMUEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:J
Last Name:SALIBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2001
Practice Address - Country:US
Practice Address - Phone:334-747-2390
Practice Address - Fax:334-747-7495
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL10346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL203204949OtherWORKMAN COMP
051032488OtherBLUE CROSS BLUE SHIELD
AL000032488Medicaid
AL051535086OtherBLUE CROSS BLUE SHIELD
AL203204949OtherCOMMERICIAL PRV
AL203204949OtherCHAMPUS
AL203204949OtherCOMMERICIAL GRP
ALP00384994OtherRAILROAD MEDICARE
AL203204949OtherUNITED HEALTHCARE
AL203204949OtherUNITED HEALTHCARE
ALP00384994OtherRAILROAD MEDICARE
AL051535086Medicare PIN