Healthcare Provider Details

I. General information

NPI: 1316153695
Provider Name (Legal Business Name): ERIC LEE SLATTERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S 900 E
SALT LAKE CITY UT
84102-1307
US

IV. Provider business mailing address

22 S 900 E
SALT LAKE CITY UT
84102-1307
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number9299963-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: