MEDICARE: DR. JOHN D SALMON 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	207Q00000X	Family Medicine Physician	2004000959	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	186411	OTHER		BLUE CROSS OF MO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871684969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN D SALMON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4046
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-4046
Country	:	US
Telephone Number	:	417-335-2299
Fax Number	:	417-269-2080

Provider Business Practice Location Address
First Line	:	890 STATE HIGHWAY 248
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-3721
Country	:	US
Telephone Number	:	417-335-2299
Fax Number	:	417-269-2080

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	12/03/2012

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