Healthcare Provider Details

I. General information

NPI: 1679540835
Provider Name (Legal Business Name): GARY D SLAVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 S RANGE AVE.
COLBY KS
67701-0806
US

IV. Provider business mailing address

PO BOX 806 1535 SOUTH RANGE AVENUE
COLBY KS
67701-0806
US

V. Phone/Fax

Practice location:
  • Phone: 785-460-8000
  • Fax: 785-460-8001
Mailing address:
  • Phone: 785-460-8000
  • Fax: 785-460-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0430102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: