Provider Demographics
NPI:1609049287
Name:SALTZ, SAMUEL LEE (DO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEE
Last Name:SALTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 E ROOSEVELT ST
Mailing Address - Street 2:DEPT. OF SURGERY
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4973
Mailing Address - Country:US
Mailing Address - Phone:602-344-5445
Mailing Address - Fax:
Practice Address - Street 1:2301 HOUSE AVE STE 507
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3179
Practice Address - Country:US
Practice Address - Phone:307-635-2562
Practice Address - Fax:307-638-2074
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49155208600000X
AZR868208600000X
WY17448C208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06977774Medicaid
CO06977774Medicaid