Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | J3615 | TX |
N | 207R00000X | Internist | J3615 | TX |
N | 111NI0900X | Internist | J3615 | TX |
NPI | 1124013560 |
---|---|
Provider Name | Dr. James Wallace Slauson |
First Address | San Angelo, TX 76902-7200 |
Second Address | San Angelo, TX 76903-5904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 19/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127626306 | (05) | TX |
127626309 | (05) | TX |
8K7851 | BCBS (01) | TX |