Provider Demographics
NPI:1497841795
Name:MEHBOOB, SALMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SALMAN
Middle Name:
Last Name:MEHBOOB
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 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:712-294-7020
Mailing Address - Fax:712-294-7022
Practice Address - Street 1:700 GARDEN VIEW CT STE 204
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-452-6334
Practice Address - Fax:760-634-9755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425449207RC0000X
CAA119955207RC0000X, 207RI0011X
IAMD-41030207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41030OtherIOWA LICENSE
NE29785OtherNEBRASKA LICENSE
MD013599200Medicaid
PAMD425449OtherLICENSE #
CAA119955OtherCALIFORNIA LICENSE