Provider Demographics
NPI:1174615157
Name:SALOMON, JAIME NUGUID JR (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:NUGUID
Last Name:SALOMON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11020 E 10TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3710
Mailing Address - Country:US
Mailing Address - Phone:317-898-5800
Mailing Address - Fax:317-898-5883
Practice Address - Street 1:11020 E 10TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3710
Practice Address - Country:US
Practice Address - Phone:317-898-5800
Practice Address - Fax:317-898-5883
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028799207R00000X
IN01028799A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1028799BOtherCONTROLLED SUBSTANCEE
IN01028799AOtherINDIANA LICENSE