Individual
ELY JEAN SALON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 RALEIGH AVE, BECKLEY, WV 25801-5989
(304) 252-8541
(304) 253-2507
Mailing address
252 RURAL ACRES DR, BECKLEY, WV 25801-3503
(304) 252-8324
(304) 252-7372
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18381
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722335
BLUE CROSS BLUE SHIELD
WV
05
—
0079492000
—
WV
01
—
2032422
MEDICATE PTAN
WV
Enumeration date
07/21/2006
Last updated
10/28/2010
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