MEDICARE: DR. PAUL PULLEN SALTER III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	6779	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051017883SAL	OTHER	AL	BLUE CROSS
2	1710199	OTHER		UNITED HEALTH CARE

General Provider Information

NPI Number	:	1548202955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL PULLEN SALTER III MD

Provider Business Mailing Address
First Line	:	PO BOX 55361
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5361
Country	:	US
Telephone Number	:	205-933-6440
Fax Number	:	205-933-6442

Provider Business Practice Location Address
First Line	:	800 ST VINCENTS DRIVE
Second Line	:	SUITE 510
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1628
Country	:	US
Telephone Number	:	205-933-6440
Fax Number	:	205-933-6442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	03/11/2010

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