Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 16053 | CA |
NPI | 1093915530 |
---|---|
Provider Name | Dr. Terry W. Slaughter W Slaughter |
First Address | Hollister, CA 95023-5613 |
Second Address | Hollister, CA 95023-5613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16053 | DENTAL LICENSE (01) | CA |
DS160531 | MEDICARE (01) | CA |
T07483 | (02) | CA |