Provider Demographics
NPI:1760737308
Name:SALEM, SALEM A (MD)
Entity Type:Individual
Prefix:DR
First Name:SALEM
Middle Name:A
Last Name:SALEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SALEM
Other - Middle Name:
Other - Last Name:SALEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE P2200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1513
Mailing Address - Country:US
Mailing Address - Phone:409-892-1192
Mailing Address - Fax:
Practice Address - Street 1:755 N 11TH ST STE P2200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1513
Practice Address - Country:US
Practice Address - Phone:409-892-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2704207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease