Healthcare Provider Details

I. General information

NPI: 1184627838
Provider Name (Legal Business Name): CLOIS DARIEN SLAUGHTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 WATER ST
LECOMPTE LA
71346-4734
US

IV. Provider business mailing address

PO BOX 399
LECOMPTE LA
71346-0399
US

V. Phone/Fax

Practice location:
  • Phone: 318-776-9340
  • Fax: 318-776-8889
Mailing address:
  • Phone: 318-776-9340
  • Fax: 318-776-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number021640
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: