Healthcare Provider Details

I. General information

NPI: 1194773911
Provider Name (Legal Business Name): DOUGLAS A SLAUGHTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 US HIGHWAY 22 STE 14
BRIDGEWATER NJ
08807-2943
US

IV. Provider business mailing address

1200 US HIGHWAY 22 STE 14
BRIDGEWATER NJ
08807-2943
US

V. Phone/Fax

Practice location:
  • Phone: 973-376-6595
  • Fax: 732-399-6475
Mailing address:
  • Phone: 973-376-6595
  • Fax: 732-399-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number22512
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME134221
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number217718
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD469501
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA09980900
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number23614
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: