MEDICARE: JEREMY D SLATER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	L8510	TX
2	2084N0600X	Clinical Neurophysiology Physician	L8510	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	164376902	OTHER	TX	CSHCN
3	8F6715	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1902833593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY D SLATER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST
Second Line	:	1014
City	:	HOUSTON
State	:	TX
Zip	:	77030-3000
Country	:	US
Telephone Number	:	832-325-7080
Fax Number	:	713-512-2239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/31/2018

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Directions to “ JEREMY D SLATER M.D.” Practice Location

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