Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0101051566 | VA |
NPI | 1598710170 |
---|---|
Provider Name | Dr. Kenneth C Slater |
First Address | Wise, VA 24293-3997 |
Second Address | Lynchburg, VA 24505-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 18/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B34613 | (02) | VA |
PENDING | (05) | VA |