Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 041219 | GA |
N | 208000000X | Pediatrician | ME123731 | FL |
Y | 2084N0402X | Child Neurologist | ME123731 | FL |
NPI | 1174550388 |
---|---|
Provider Name | John Thomas Sladky |
First Address | Gainesville, FL 32610-0296 |
Second Address | Gainesville, FL 32610-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000686694C | (05) | GA |
014945300 | (05) | FL |
C29403 | (02) |