Individual
DR. TY A SALNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
845 W CENTER ST, SUITE 200, POCATELLO, ID 83204-4205
(208) 232-6260
(208) 232-6259
Mailing address
PO BOX 2377, POCATELLO, ID 83206-2377
(208) 232-7862
(208) 232-7869
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M9343
ID
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
M9343
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8073119
—
ID
01
—
B5569
BLUE CROSS-POCATELLO
ID
Enumeration date
06/14/2006
Last updated
10/30/2013
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