Healthcare Provider Details

I. General information

NPI: 1952396459
Provider Name (Legal Business Name): EMERY M. SALOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE SUITE 702
HIALEAH FL
33016-1897
US

IV. Provider business mailing address

12741 MIRAMAR PKWY STE 302
MIRAMAR FL
33027-2905
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-8688
  • Fax: 305-828-8655
Mailing address:
  • Phone: 954-602-9723
  • Fax: 954-602-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME77021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: