Healthcare Provider Details

I. General information

NPI: 1730146994
Provider Name (Legal Business Name): JESSE SALMERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 NE 163RD ST STE 505
NORTH MIAMI BEACH FL
33160-4423
US

IV. Provider business mailing address

PO BOX 640885
MIAMI FL
33164-0885
US

V. Phone/Fax

Practice location:
  • Phone: 305-652-8151
  • Fax: 305-651-7257
Mailing address:
  • Phone: 305-652-8151
  • Fax: 305-651-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME0075831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: