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General NPI Number Information
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NPI Number | 1730174897
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Entity Type | Individual
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Provider Name | MALCOLM WALTON SLATON PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 1014 PRIMROSE AVE
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City | LONGMONT
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State | CO
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Zip | 80301
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Country | US
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Telephone | 303-704-6504
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Fax | 720-652-4774
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Provider Business Mailing Address
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Address Line | 5704 CAPISTRANO WAY
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City | FREDERICK
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State | CO
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Zip | 80504-9712
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Country | US
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Telephone | 303-704-6504
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Fax | 720-652-4774
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 919
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 919
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 521
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 103150
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 212
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License Number State | IL
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