Healthcare Provider Details

I. General information

NPI: 1164452207
Provider Name (Legal Business Name): ROBERT C SALEK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80B VETERAN BLVD
ACOMA NM
87034
US

IV. Provider business mailing address

PO BOX 130
SAN FIDEL NM
87049-0130
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5358
  • Fax: 505-552-5805
Mailing address:
  • Phone: 505-552-5358
  • Fax: 505-552-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM0000000650
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: