Provider Demographics
NPI:1356430326
Name:SALMON, GRETCHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:J
Last Name:SALMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67-1123 MAMALAHOA HWY
Mailing Address - Street 2:STE 128
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8451
Mailing Address - Country:US
Mailing Address - Phone:808-885-7351
Mailing Address - Fax:808-885-4120
Practice Address - Street 1:45-493C ILIMA STREET
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-1363
Practice Address - Country:US
Practice Address - Phone:808-775-7258
Practice Address - Fax:808-775-8062
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3722208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04761801Medicaid
HI0000BDRZHMedicare ID - Type Unspecified
HIE72013Medicare UPIN