Provider Demographics
NPI:1679741524
Name:SALZMAN, CHRISTOPHER WILLARD VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WILLARD VINCENT
Last Name:SALZMAN
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 1:414 ZEAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3815
Mailing Address - Country:US
Mailing Address - Phone:386-328-4123
Mailing Address - Fax:
Practice Address - Street 1:414 ZEAGLER DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3815
Practice Address - Country:US
Practice Address - Phone:386-328-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114481208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008654400Medicaid
FL008654400Medicaid