Provider Demographics
NPI:1245464445
Name:SALAHSHOUR, JONATHAN R (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:SALAHSHOUR
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 1:560 GAGE BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8650
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:
Practice Address - Street 1:1100 GOETHALS DRIVE, STE B
Practice Address - Street 2:KADLEC CLINIC NEUROSCIENCE CENTER
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-3080
Practice Address - Fax:509-942-3085
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60533524208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163118Medicare PIN