Provider Demographics
NPI:1730146994
Name:SALMERON, JESSE (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:SALMERON
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:PO BOX 640885
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33164-0885
Mailing Address - Country:US
Mailing Address - Phone:305-652-8151
Mailing Address - Fax:305-651-7257
Practice Address - Street 1:3363 NE 163RD ST STE 505
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4423
Practice Address - Country:US
Practice Address - Phone:305-652-8151
Practice Address - Fax:305-651-7257
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075831207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255800900Medicaid
G68368Medicare UPIN