Provider Demographics
NPI:1477558500
Name:SALCEDO, WILLIAM (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S E PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952
Mailing Address - Country:US
Mailing Address - Phone:772-337-0014
Mailing Address - Fax:772-398-0887
Practice Address - Street 1:1331 SE PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5331
Practice Address - Country:US
Practice Address - Phone:772-337-0014
Practice Address - Fax:772-398-0887
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2253213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65266OtherBC/BS OF FL
FL480029323OtherMEDICARE RAIL ROAD
FL1477558500OtherOTHER INSURANCES
FL390067300Medicaid
FL480029323OtherMEDICARE RAIL ROAD
FL0961430001Medicare NSC