Provider Demographics
NPI:1023089406
Name:SALOMON, JETH V (MD)
Entity type:Individual
Prefix:
First Name:JETH
Middle Name:V
Last Name:SALOMON
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 1:6560 9TH AVE N STE 1
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6210
Mailing Address - Country:US
Mailing Address - Phone:727-381-5437
Mailing Address - Fax:727-344-0632
Practice Address - Street 1:6399 38TH AVE N
Practice Address - Street 2:SUITE A-6
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1647
Practice Address - Country:US
Practice Address - Phone:727-381-5437
Practice Address - Fax:727-344-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068237174400000X
FLME68237208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378171200Medicaid
FL27040Medicare ID - Type Unspecified