Provider Demographics
NPI:1477526994
Name:SLATER, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SLATER
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 1:1395 E ELDORADO PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5508
Mailing Address - Country:US
Mailing Address - Phone:469-200-5974
Mailing Address - Fax:469-200-5214
Practice Address - Street 1:1395 E ELDORADO PKWY STE 400
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5508
Practice Address - Country:US
Practice Address - Phone:469-200-5974
Practice Address - Fax:469-200-5214
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1202207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184671904Medicaid
TX184671901Medicaid
TXTXB123204Medicare PIN
TX8214M1Medicare PIN
TX184671904Medicaid
TX184671901Medicaid