Provider Demographics
NPI:1437114519
Name:SALTS, LARRY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:THOMAS
Last Name:SALTS
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 1:4841 E MOUNTAIN VIEW
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253
Mailing Address - Country:US
Mailing Address - Phone:602-882-2106
Mailing Address - Fax:602-882-2106
Practice Address - Street 1:1111 E MCDOWELL ROAD
Practice Address - Street 2:BANNER GOOD SAMARITAN REGIONAL MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-239-2147
Practice Address - Fax:602-239-2581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9138207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
227050OtherAHCCCS
D44451Medicare UPIN
271916Medicare ID - Type Unspecified