Healthcare Provider Details

I. General information

NPI: 1760467492
Provider Name (Legal Business Name): ROBERT STEVEN SLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN MCEUL DCCS (CREDENTIALS), CMR 402
APO AE
09180
US

IV. Provider business mailing address

CMR 427 BOX 2278
APO AE
09630
US

V. Phone/Fax

Practice location:
  • Phone: 011496371868839
  • Fax:
Mailing address:
  • Phone: 393351201124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA52230
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA52230
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA52230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: