Healthcare Provider Details

I. General information

NPI: 1033777578
Provider Name (Legal Business Name): JOHN ELLIOTT SALOMONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE # 002103
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE # 002103
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-7376
  • Fax: 314-454-7120
Mailing address:
  • Phone: 314-454-7376
  • Fax: 314-454-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR-11504
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number2022019819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: