Provider Demographics
NPI:1699740399
Name:SALEH, EDWARD F (PA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:F
Last Name:SALEH
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Gender:M
Credentials:PA
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Mailing Address - Street 1:800 PRUDENTIAL DR
Mailing Address - Street 2:TOWER B, 11TH FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8202
Mailing Address - Country:US
Mailing Address - Phone:904-388-6518
Mailing Address - Fax:904-384-1005
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:TOWER B, 11TH FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-388-6518
Practice Address - Fax:904-384-1005
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-06-09
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103275363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2922096-00Medicaid
GA905561889AMedicaid
FLU5290YMedicare PIN
GA905561889AMedicaid