Provider Demographics
NPI:1487662912
Name:SLATER, MATTHEW SIMON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SIMON
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 1:2500 NE NEFF ROAD
Mailing Address - Street 2:ST. CHARLES MEDICAL CENTER
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6353
Mailing Address - Country:US
Mailing Address - Phone:541-382-4321
Mailing Address - Fax:541-706-2991
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-388-4333
Practice Address - Fax:541-388-3446
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18895208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150101Medicaid
OR150101Medicaid