Healthcare Provider Details

I. General information

NPI: 1568441012
Provider Name (Legal Business Name): WADDAH SALMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 BEACH BLVD
JACKSONVILLE FL
32216-2891
US

IV. Provider business mailing address

6444 BEACH BLVD
JACKSONVILLE FL
32216-2891
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-9600
  • Fax: 904-805-0084
Mailing address:
  • Phone: 904-805-9600
  • Fax: 904-805-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME98532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: