Healthcare Provider Details

I. General information

NPI: 1417907106
Provider Name (Legal Business Name): DICK D SLATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 N PECOS RD
N LAS VEGAS NV
89086-4400
US

IV. Provider business mailing address

6900 N PECOS RD
N LAS VEGAS NV
89086-4400
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9000
  • Fax: 877-300-0864
Mailing address:
  • Phone: 702-791-9000
  • Fax: 877-300-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number18656
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: