Healthcare Provider Details

I. General information

NPI: 1134657745
Provider Name (Legal Business Name): ROBERT PAUL SLAUGHTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

139 BRACKENRIDGE AVE
SAN ANTONIO TX
78209-7031
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-8212
  • Fax:
Mailing address:
  • Phone: 504-491-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN124357
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number908446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: