Healthcare Provider Details

I. General information

NPI: 1477558500
Provider Name (Legal Business Name): WILLIAM SALCEDO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 NW FEDERAL HWY # 245
STUART FL
34994-9315
US

IV. Provider business mailing address

2515 NW FEDERAL HWY # 245
STUART FL
34994-9315
US

V. Phone/Fax

Practice location:
  • Phone: 772-631-3326
  • Fax: 772-283-8087
Mailing address:
  • Phone: 772-631-3326
  • Fax: 772-283-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2253
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO2253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: