Provider Demographics
NPI:1578608220
Name:MUDDASSIR, SALMAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SALMAN
Middle Name:M
Last Name:MUDDASSIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14690 SPRING HILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:9030 W FORT ISLAND TRL STE 1
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8011
Practice Address - Country:US
Practice Address - Phone:352-228-8906
Practice Address - Fax:352-228-8905
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08169300207R00000X
FLME122573208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
261649038OtherHORIZON BCBS
NJ0182834Medicaid
3840780OtherCOVENTRY & FIRST HEALTH
NJ60082604OtherHORIZON NJ HEALTH
3580249000OtherKEYSTONE HEALTH PLAN EAST PCP
05200993OtherCIGNA
NJ3580249000OtherAMERIHEALTH
9474147OtherAETNA PPO
6441184OtherAETNA HMO PCP
NJ0182834Medicaid