Provider Demographics
NPI:1699724286
Name:SALAS, ALFRED GENOVEO (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:GENOVEO
Last Name:SALAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALFRED
Other - Middle Name:G
Other - Last Name:SALAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5800 COLONIAL DR
Mailing Address - Street 2:STE 206
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5682
Mailing Address - Country:US
Mailing Address - Phone:954-974-3161
Mailing Address - Fax:954-974-3189
Practice Address - Street 1:5800 COLONIAL DR
Practice Address - Street 2:STE 206
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5682
Practice Address - Country:US
Practice Address - Phone:954-974-3161
Practice Address - Fax:954-974-3189
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026320207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D78825Medicare UPIN
FL93779Medicare ID - Type Unspecified