Individual
DR. GOHAR A SALAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Contact information
Practice address
11188 DIEBOLD RD, FORT WAYNE, IN 46845-9662
(260) 483-9500
(260) 483-9511
Mailing address
11188 DIEBOLD RD, FORT WAYNE, IN 46845-9662
(260) 483-9500
(260) 483-9511
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01058885A
IN
261QA1903X
Ambulatory Surgical Clinic/Center
130127411
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364631
ANTHEM
IN
01
—
17842
PHP
IN
05
—
200484720A
—
IN
01
—
7800696
AETNA
IN
Enumeration date
08/10/2005
Last updated
03/02/2016
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