MEDICARE: DR. ALLEN J SALEM 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	K9165	TX
2	207RP1001X	Pulmonary Disease Physician	K9165	TX
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	K9165	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0033HG	OTHER	TX	BCBS
2	0033HGT	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992797088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN J SALEM M.D.

Provider Business Mailing Address
First Line	:	2442 E. 25TH ST.
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-0000
Country	:	US
Telephone Number	:	208-552-4909
Fax Number	:	940-612-3636

Provider Business Practice Location Address
First Line	:	2442 E. 25TH ST.
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-0000
Country	:	US
Telephone Number	:	208-552-4909
Fax Number	:	940-612-3636

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/22/2011

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Directions to “ DR. ALLEN J SALEM M.D.” Practice Location

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