=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659331858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FIRAS SALEH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2202 STATE AVE STE 201
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32405-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-785-0029
-----------------------------------------------------
Fax | 850-785-7600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2202 STATE AVE STE 201
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32405-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-785-0029
-----------------------------------------------------
Fax | 850-785-7600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | ME93796
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------