Provider Demographics
NPI:1548675473
Name:SALYER, JONNY LORRAINE (MD)
Entity type:Individual
Prefix:DR
First Name:JONNY
Middle Name:LORRAINE
Last Name:SALYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JONNY
Other - Middle Name:LORRAINE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 CAMINO DE LA SIERRA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4938
Mailing Address - Country:US
Mailing Address - Phone:317-910-2402
Mailing Address - Fax:
Practice Address - Street 1:2441 RIDGECREST DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5129
Practice Address - Country:US
Practice Address - Phone:505-348-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-297207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology