Provider Demographics
NPI:1346206265
Name:SLAUGHTER-JONES, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:SLAUGHTER-JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 UNITY ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4429
Mailing Address - Country:US
Mailing Address - Phone:360-676-6177
Mailing Address - Fax:360-527-8778
Practice Address - Street 1:5616 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-752-7410
Practice Address - Fax:360-383-0808
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA161836OtherL & I
WA8317125Medicaid
WAAB32748Medicare ID - Type Unspecified
H31074Medicare UPIN