MEDICARE: EDWIN MANUEL SALAMANCA MD

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	174400000X	Specialist	ME64430	FL

General Provider Information

NPI Number	:	1952353971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN MANUEL SALAMANCA MD

Provider Business Mailing Address
First Line	:	PO BOX 667
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33836-0667
Country	:	US
Telephone Number	:	863-421-7600
Fax Number	:	863-421-7551

Provider Business Practice Location Address
First Line	:	2221 NORTH BLVD W
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8990
Country	:	US
Telephone Number	:	863-421-7600
Fax Number	:	863-421-7551

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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