Individual
DALE GRAHAM SALATICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
ME53091
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049534400
—
FL
01
—
05974
BLUE CROSS BLUE SHIELD
FL
01
—
4071383
AETNA PROVIDER ID
FL
01
—
623763
AENTA PROVIDER ID
FL
01
—
FEIN
593490701
FL
Enumeration date
05/31/2005
Last updated
10/20/2013
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