Healthcare Provider Details

I. General information

NPI: 1376535856
Provider Name (Legal Business Name): THOMAS MICHAEL SLYTER M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 E LEOLA LN
PORT ORCHARD WA
98366-8226
US

IV. Provider business mailing address

6414 E LEOLA LN
PORT ORCHARD WA
98366-8226
US

V. Phone/Fax

Practice location:
  • Phone: 505-681-6148
  • Fax:
Mailing address:
  • Phone: 505-681-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberMD00034514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: