Provider Demographics
NPI:1760827638
Name:SALMON, THADDEUS ROBERT III (MD)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:ROBERT
Last Name:SALMON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THAD
Other - Middle Name:
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 S LIMESTONE CTW306 DIV OF GENERAL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-0200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UK POLK DALTON CLINIC
Practice Address - Street 2:217 ELM TREE LN
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40500
Practice Address - Country:US
Practice Address - Phone:859-257-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49988208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics