Provider Demographics
NPI:1326622630
Name:SLAKER, DIRK PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:PAUL
Last Name:SLAKER
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 1:800 EVERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-6070
Mailing Address - Country:US
Mailing Address - Phone:858-837-1907
Mailing Address - Fax:
Practice Address - Street 1:800 EVERVILLE DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-6070
Practice Address - Country:US
Practice Address - Phone:858-837-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty