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General NPI Number Information
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NPI Number | 1790723690
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Entity Type | Organization
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Legal Business Name | RANDALL J SLICKERS, M.D., P.C.
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1235 FILER AVE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-4118
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Country | US
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Telephone | 208-734-3226
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Fax | 208-734-3675
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Provider Business Mailing Address
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Address Line | 1235 FILER AVE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-4118
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Country | US
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Telephone | 208-734-3226
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Fax | 208-734-3675
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RANDALL J SLICKERS
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Credential | M.D.
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Telephone | 208-734-3226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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