Healthcare Provider Details

I. General information

NPI: 1871669788
Provider Name (Legal Business Name): LARRY SLATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 STONY CIR STE 1600
SANTA ROSA CA
95401
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-7700
  • Fax: 707-573-5415
Mailing address:
  • Phone: 707-541-7700
  • Fax: 707-573-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number247985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: