MEDICARE: SAMER ABDELWAHAB SALEH M.D.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	8449093-1205	UT
2	207RP1001X	Pulmonary Disease Physician	A81808	CA
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	8449093-1205	UT
4	207RP1001X	Pulmonary Disease Physician	8449093-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5812	OTHER	SD	SD STATE LICENSE

General Provider Information

NPI Number	:	1205931037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMER ABDELWAHAB SALEH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-7291
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 W COUGAR BLVD FL 5
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3323
Country	:	US
Telephone Number	:	801-357-7291
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/27/2024

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