Provider Demographics
NPI:1992797088
Name:SALEM, ALLEN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:J
Last Name:SALEM
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 1:2442 E. 25TH ST.
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-0000
Mailing Address - Country:US
Mailing Address - Phone:208-552-4909
Mailing Address - Fax:940-612-3636
Practice Address - Street 1:2442 E. 25TH ST.
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-0000
Practice Address - Country:US
Practice Address - Phone:208-552-4909
Practice Address - Fax:940-612-3636
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9165174400000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0033HGOtherBCBS
TX0033HGTOtherBCBS
TX042379003Medicaid
TXE92799Medicare UPIN