Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 6779 | TX |
N | 111NR0200X | Radiology | 6779 | TX |
N | 213ER0200X | Radiology | 6779 | TX |
N | 111NX0100X | Occupational Health | 6779 | TX |
Y | 363L00000X | Nurse Practitioner | 776723 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 776723 | TX |
NPI | 1073500955 |
---|---|
Provider Name | John Earl Slaughter |
First Address | La Porte, TX 77571-4496 |
Second Address | La Porte, TX 77571-4496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 12/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AR810 | BCBS (01) | |
8BL830 | BCBS (01) | TX |
8P5800 | BLUE CROSS BLUE SHIELD (01) | TX |
U64886 | (02) | TX |