Provider Demographics
NPI:1417789926
Name:SALLIE, ROBERT E
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SALLIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COURT AVE
Mailing Address - Street 2:STE 820 #889160
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309
Mailing Address - Country:US
Mailing Address - Phone:515-721-6662
Mailing Address - Fax:
Practice Address - Street 1:309 COURT AVE
Practice Address - Street 2:STE 820 #889160
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309
Practice Address - Country:US
Practice Address - Phone:515-721-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver