Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 25032 | CA |
NPI | 1336112721 |
---|---|
Provider Name | Dr. Lee James Slater |
First Address | San Diego, CA 92131-3524 |
Second Address | San Diego, CA 92122-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 08/07/2007 |