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General NPI Number Information
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NPI Number | 1548675473
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Entity Type | Individual
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Provider Name | JONNY LORRAINE SALYER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 2441 RIDGECREST DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5129
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Country | US
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Telephone | 505-348-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 CAMINO DE LA SIERRA NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-4938
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Country | US
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Telephone | 317-910-2402
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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 | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | 91-297
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License Number State | NM
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