Healthcare Provider Details

I. General information

NPI: 1396839965
Provider Name (Legal Business Name): BOB S SALK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO STREET, STE #315
SAN FRANCISCO CA
94114
US

IV. Provider business mailing address

45 CASTRO STREET, STE #315
SAN FRANCISCO CA
94114
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4307
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code193400000X
TaxonomySingle Specialty Group
License NumberE4307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: