Provider Demographics
NPI:1528018512
Name:SLAVIN, HERBERT RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:RICHARD
Last Name:SLAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HERBERT
Other - Middle Name:R
Other - Last Name:SLAVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7200 W COMMERCIAL BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2148
Mailing Address - Country:US
Mailing Address - Phone:954-748-4991
Mailing Address - Fax:954-748-5022
Practice Address - Street 1:7200 W COMMERCIAL BLVD
Practice Address - Street 2:STE 210
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2148
Practice Address - Country:US
Practice Address - Phone:954-748-4991
Practice Address - Fax:954-748-5022
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00036889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93955OtherBCBS
FL110119829OtherRAILROAD MC
93955Medicare ID - Type Unspecified
FL110119829OtherRAILROAD MC
FL93955Medicare PIN