Healthcare Provider Details

I. General information

NPI: 1972940526
Provider Name (Legal Business Name): ROBERT THOMAS SLATER III M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1385
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1385
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-2166
  • Fax: 409-772-2663
Mailing address:
  • Phone: 409-772-2166
  • Fax: 409-772-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ5279
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: