Provider Demographics
NPI:1619962602
Name:SALTZ, ELLIOTT J (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:J
Last Name:SALTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0203
Mailing Address - Country:US
Mailing Address - Phone:256-593-1234
Mailing Address - Fax:256-593-8553
Practice Address - Street 1:3442 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0203
Practice Address - Country:US
Practice Address - Phone:256-593-1234
Practice Address - Fax:256-593-8553
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009971715Medicaid
AL051524635Medicare ID - Type Unspecified
AL009971715Medicaid