Individual
JERRY R SALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
710 RIVERSIDE DR, WAUPACA, WI 54981-1941
(715) 258-1160
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3298
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14059-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31229600
—
WI
Enumeration date
07/01/2006
Last updated
07/08/2007
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