Provider Demographics
NPI:1689967796
Name:SALTER, JOSHUA ETHAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ETHAN
Last Name:SALTER
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:PEACEHEALTH HOSPITAL MEDICINE
Mailing Address - Street 2:3377 RIVERBEND DRIVE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:541-222-6389
Mailing Address - Fax:541-222-6385
Practice Address - Street 1:PEACEHEALTH HOSPITAL MEDICINE
Practice Address - Street 2:3377 RIVERBEND DRIVE
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-6389
Practice Address - Fax:541-222-6385
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3887207Q00000X
ORMD179591208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717445Medicaid