Healthcare Provider Details

I. General information

NPI: 1063595924
Provider Name (Legal Business Name): MARTIN E. SALM, M.D., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 KINGSBURY GRADE, SUITE 101
STATELINE NV
89449-5910
US

IV. Provider business mailing address

276 KINGSBURY GRADE, SUITE 101 P.O. BOX 5910
STATELINE NV
89449-5910
US

V. Phone/Fax

Practice location:
  • Phone: 775-588-5000
  • Fax: 775-588-5001
Mailing address:
  • Phone: 775-588-5000
  • Fax: 775-588-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number6357
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number6357
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number6357
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number6357
License Number StateNV

VIII. Authorized Official

Name: MARTIN E. SALM
Title or Position: PRESIDENT / OWNER
Credential: M.D.
Phone: 775-588-5000