Individual
MOTI SALLOUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
269 S CANDY LN, COTTONWOOD, AZ 86326-4158
(928) 639-5588
(928) 639-5589
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 773-2559
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31775
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
930877
—
AZ
01
—
AZ0738080
BCBS
AZ
01
—
P00203449
RR MC
AZ
Enumeration date
11/30/2006
Last updated
01/04/2016
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