Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4945 | CA |
N | 213ES0131X | Foot Surgery | 41000226A | IN |
NPI | 1154576239 |
---|---|
Provider Name | Dr. Brandon James Slade |
First Address | San Luis Obispo, CA 93401-4635 |
Second Address | San Luis Obispo, CA 93401-4635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 12/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FH048Z | PTAN (01) | CA |