Healthcare Provider Details

I. General information

NPI: 1326350752
Provider Name (Legal Business Name): ELIZABETH JANE SALADIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S SANTA FE AVE STE 122
MOORE OK
73160-3081
US

IV. Provider business mailing address

3200 S SANTA FE AVE STE 122
MOORE OK
73160-3081
US

V. Phone/Fax

Practice location:
  • Phone: 405-362-1872
  • Fax: 405-646-1155
Mailing address:
  • Phone: 405-362-1872
  • Fax: 405-646-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33046
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: