Healthcare Provider Details

I. General information

NPI: 1639192495
Provider Name (Legal Business Name): JOSEPH O SLOTKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST
COVINGTON WA
98042-4951
US

IV. Provider business mailing address

17700 SE 272ND ST
COVINGTON WA
98042-4951
US

V. Phone/Fax

Practice location:
  • Phone: 253-372-7100
  • Fax:
Mailing address:
  • Phone: 253-372-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00032352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: