Healthcare Provider Details

I. General information

NPI: 1932274834
Provider Name (Legal Business Name): SALMAN MASUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E. 300 N.
SALT LAKE CITY UT
84103-4399
US

IV. Provider business mailing address

1900 JEREMY DR
SALT LAKE CITY UT
84121-2169
US

V. Phone/Fax

Practice location:
  • Phone: 801-536-3600
  • Fax: 801-536-3868
Mailing address:
  • Phone: 801-424-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number309097-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: