Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC 25181 | CA |
NPI | 1457576019 |
---|---|
Provider Name | Dr. Timothy M. Slone |
First Address | Granite Bay, CA 95746-6284 |
Second Address | Granite Bay, CA 95746-6284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |