Provider Demographics
NPI:1821041666
Name:SALARD, GREG ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALAN
Last Name:SALARD
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:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:WRANGELL
Mailing Address - State:AK
Mailing Address - Zip Code:99929
Mailing Address - Country:US
Mailing Address - Phone:907-874-4700
Mailing Address - Fax:
Practice Address - Street 1:320 BENNETT STREET
Practice Address - Street 2:
Practice Address - City:WRANGELL
Practice Address - State:AK
Practice Address - Zip Code:99929
Practice Address - Country:US
Practice Address - Phone:907-874-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4681207Q00000X
LA026081207Q00000X
AK5052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05413Medicaid
OK200092570AMedicaid
AR161466001Medicaid
AR161466001Medicaid