MEDICARE: DR. MARY BETH SALMONSEN 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	OS17964	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881884401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BETH SALMONSEN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9560
Fax Number	:	239-343-9624

Provider Business Practice Location Address
First Line	:	8925 COLONIAL CENTER DR STE 1000
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7813
Country	:	US
Telephone Number	:	239-343-9560
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	05/10/2023

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