MEDICARE: DR. BETHANY SLECKMAN 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	207RX0202X	Medical Oncology Physician	2002027895	MO

General Provider Information

NPI Number	:	1861814386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETHANY SLECKMAN M.D.

Provider Business Mailing Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3425
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-7057
Fax Number	:	314-251-5665

Provider Business Practice Location Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3425
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-7057
Fax Number	:	314-251-5665

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

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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