Healthcare Provider Details

I. General information

NPI: 1487662912
Provider Name (Legal Business Name): MATTHEW SIMON SLATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701-6015
US

IV. Provider business mailing address

2500 NE NEFF ROAD ST. CHARLES MEDICAL CENTER
BEND OR
97701-6353
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-4333
  • Fax: 541-388-3446
Mailing address:
  • Phone: 541-382-4321
  • Fax: 541-706-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD18895
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier150101
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: