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General NPI Number Information
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NPI Number | 1295790384
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Entity Type | Organization
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Legal Business Name | BRIGHAM ANESTHESIA SPECIALISTS LTD
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1111 E MCDOWELL ROAD BANNER GOOD SAMARITAN REGIONAL MEDICAL CENTER
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City | PHOENIX
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State | AZ
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Zip | 85006
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Country | US
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Telephone | 602-239-2147
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Fax | 602-239-2581
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Provider Business Mailing Address
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Address Line | PO BOX 15151
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City | PHOENIX
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State | AZ
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Zip | 85060-5151
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Country | US
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Telephone | 602-882-2106
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY THOMAS SALTS
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Credential | MD
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Telephone | 602-882-2106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 9138
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License Number State | AZ
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