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General NPI Number Information
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NPI Number | 1760827638
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Entity Type | Individual
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Provider Name | THADDEUS ROBERT SALMON III M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | UK POLK DALTON CLINIC 217 ELM TREE LN
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City | LEXINGTON
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State | KY
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Zip | 40500
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Country | US
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Telephone | 859-257-8801
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Fax |
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Provider Business Mailing Address
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Address Line | 900 S LIMESTONE CTW306 DIV OF GENERAL
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City | LEXINGTON
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State | KY
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Zip | 40506-0200
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 49988
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 49988
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License Number State | KY
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