Healthcare Provider Details

I. General information

NPI: 1851661847
Provider Name (Legal Business Name): DAVID WAYNE SLIGHT CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SPRUCE DR APT 6108
ARLINGTON TX
76018-5620
US

IV. Provider business mailing address

4600 SPRUCE DR APT 6108
ARLINGTON TX
76018-5620
US

V. Phone/Fax

Practice location:
  • Phone: 817-800-4219
  • Fax:
Mailing address:
  • Phone: 817-800-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number3869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: