Healthcare Provider Details

I. General information

NPI: 1043317779
Provider Name (Legal Business Name): GERALD FRANCIS SLONKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 BLUFF DR
PARKVILLE MO
64152
US

IV. Provider business mailing address

5213 BLUFF DR
PARKVILLE MO
64152
US

V. Phone/Fax

Practice location:
  • Phone: 816-746-0675
  • Fax:
Mailing address:
  • Phone: 816-746-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR5G79
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: