MEDICARE: DR. FREDERICK ALLEN SALAMON 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	174400000X	Specialist	5385	AZ

General Provider Information

NPI Number	:	1982974473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK ALLEN SALAMON M.D.

Provider Business Mailing Address
First Line	:	4447 E SUNSET DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6112
Country	:	US
Telephone Number	:	480-998-8031
Fax Number	:

Provider Business Practice Location Address
First Line	:	4447 E SUNSET DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6112
Country	:	US
Telephone Number	:	480-998-8031
Fax Number	:

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

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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