Provider Demographics
NPI:1205870656
Name:SALLOUM, NAIM JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:NAIM
Middle Name:JOSEPH
Last Name:SALLOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15158
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5158
Mailing Address - Country:US
Mailing Address - Phone:601-288-1700
Mailing Address - Fax:601-288-1715
Practice Address - Street 1:301 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7233
Practice Address - Country:US
Practice Address - Phone:601-288-1700
Practice Address - Fax:601-288-1715
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS116502085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116005Medicaid
MSA60678Medicare UPIN