MEDICARE: MELVIN BORIS SALTZMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	R5B20	MO

General Provider Information

NPI Number	:	1124025416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN BORIS SALTZMAN D.O.

Provider Business Mailing Address
First Line	:	12277 DE PAUL DR
Second Line	:	STE 404
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2536
Country	:	US
Telephone Number	:	314-770-1000
Fax Number	:	314-770-2456

Provider Business Practice Location Address
First Line	:	12277 DE PAUL DR
Second Line	:	STE 404
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2536
Country	:	US
Telephone Number	:	314-770-1000
Fax Number	:	314-770-2456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/17/2011

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