Provider Demographics
NPI:1932395944
Name:SALVA, MAXIM ESLAO (MD)
Entity Type:Individual
Prefix:MR
First Name:MAXIM
Middle Name:ESLAO
Last Name:SALVA
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 1:3632 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3164
Mailing Address - Country:US
Mailing Address - Phone:307-234-6765
Mailing Address - Fax:305-234-6998
Practice Address - Street 1:3632 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3164
Practice Address - Country:US
Practice Address - Phone:307-234-6765
Practice Address - Fax:307-234-6998
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13172A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty