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General NPI Number Information
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NPI Number | 1013169879
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Entity Type | Individual
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Provider Name | KENNETH VERNON SLACK MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 7727 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32822-8224
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Country | US
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Telephone | 407-303-6413
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Fax |
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Provider Business Mailing Address
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Address Line | 7727 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32822-8224
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Country | US
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Telephone | 407-303-6413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | TRN18079
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24792
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME119973
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License Number State | FL
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