Healthcare Provider Details

I. General information

NPI: 1619972585
Provider Name (Legal Business Name): ALEXANDRE LEONI SLATKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH ST STE 5A
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

201 4TH ST STE 5A
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-1249
  • Fax: 318-448-9644
Mailing address:
  • Phone: 318-448-1249
  • Fax: 318-448-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number04113R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: