Healthcare Provider Details

I. General information

NPI: 1780640953
Provider Name (Legal Business Name): SALVATORE D DILORETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR STE 112 CREDENTIALING DEPARTMENT
JACKSONVILLE FL
32207-8204
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-5996
  • Fax: 904-398-2480
Mailing address:
  • Phone: 904-398-3760
  • Fax: 904-398-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME62183
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberME62183
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME62183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: