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General NPI Number Information
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NPI Number | 1487604930
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Entity Type | Individual
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Provider Name | SALAH ANTAR MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 12902 USF MAGNOLIA DR STE 200
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City | TAMPA
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State | FL
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Zip | 33612-9416
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Country | US
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Telephone | 813-745-4673
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Fax | 941-308-8508
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Provider Business Mailing Address
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Address Line | PO BOX 198441
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City | ATLANTA
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State | GA
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Zip | 30384-8441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME 66188
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | ME66188
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License Number State | FL
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