Basic Information
| Provider Information | |||||||||
| NPI: | 1609049287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALTZ | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 E ROOSEVELT ST | ||||||||
| Address2: | DEPT. OF SURGERY | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850084973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023445445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 15TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806314500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703528216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2008 | ||||||||
| LastUpdateDate: | 12/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R868 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 49155 | CO | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 06977774 | 05 | CO | MEDICAID |