Provider Demographics
NPI:1437509783
Name:SALAMON, AVI (MD)
Entity Type:Individual
Prefix:DR
First Name:AVI
Middle Name:
Last Name:SALAMON
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 1:1960 N OGDEN ST
Mailing Address - Street 2:STE 400
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3670
Mailing Address - Country:US
Mailing Address - Phone:303-318-1540
Mailing Address - Fax:303-318-2481
Practice Address - Street 1:1375 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1114
Practice Address - Country:US
Practice Address - Phone:303-812-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062654207Q00000X, 208M00000X
COTL 0006260390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029324OtherKAISER COMMERCIAL NUMBER
CO9000137623Medicaid