Provider Demographics
NPI:1184627838
Name:SLAUGHTER, CLOIS DARIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLOIS
Middle Name:DARIEN
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:LECOMPTE
Mailing Address - State:LA
Mailing Address - Zip Code:71346-0399
Mailing Address - Country:US
Mailing Address - Phone:318-776-9340
Mailing Address - Fax:318-776-8889
Practice Address - Street 1:1610 WATER ST
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346-4734
Practice Address - Country:US
Practice Address - Phone:318-776-9340
Practice Address - Fax:318-776-8889
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1684350Medicaid
LA5Y075Medicare PIN
LAF58979Medicare UPIN