Provider Demographics
NPI:1528040409
Name:SALIB, MARY YASSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:YASSA
Last Name:SALIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 N HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-9596
Mailing Address - Country:US
Mailing Address - Phone:850-937-4004
Mailing Address - Fax:850-937-4006
Practice Address - Street 1:749 N HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-9596
Practice Address - Country:US
Practice Address - Phone:850-937-4004
Practice Address - Fax:850-937-4006
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44104OtherBCBS FL
FL270450100Medicaid
FLME87968OtherMEDICAL LICENSE NUMBER
FL810657750OtherCIGNA
FLK8350OtherMEDICARE GROUP
FLME87968OtherMEDICAL LICENSE NUMBER
FL810657750OtherCIGNA