Healthcare Provider Details

I. General information

NPI: 1609842954
Provider Name (Legal Business Name): ROBERT SLACKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/18/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CENTRAL AVE
SARASOTA FL
34236-4042
US

IV. Provider business mailing address

736 CENTRAL AVE
SARASOTA FL
34236-4042
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-4099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101-053475
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number0101-053475
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: