MEDICARE: JAMES B SLATTERY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	ME29135	FL

General Provider Information

NPI Number	:	1053317875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES B SLATTERY M.D.

Provider Business Mailing Address
First Line	:	250 SW 131ST ST
Second Line	:
City	:	NEWBERRY
State	:	FL
Zip	:	32669-3074
Country	:	US
Telephone Number	:	352-331-7539
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 W NEWBERRY RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2245
Country	:	US
Telephone Number	:	352-336-6000
Fax Number	:	352-332-0799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/06/2014

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