Provider Demographics
NPI:1952656274
Name:BRIAN G SALISBURY MD PA
Entity Type:Organization
Organization Name:BRIAN G SALISBURY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-441-9444
Mailing Address - Street 1:1305 S FORT HARRISON AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3301
Mailing Address - Country:US
Mailing Address - Phone:727-441-9444
Mailing Address - Fax:727-443-2728
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:BLDG D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-441-9444
Practice Address - Fax:727-443-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0023852207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGJ108AOtherMEDICARE PTAN