Provider Demographics
NPI:1578774402
Name:SLISH, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SLISH
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 1:1329 SW 16TH ST # 4270
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICAL SERVICES
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1128
Mailing Address - Country:US
Mailing Address - Phone:352-265-5911
Mailing Address - Fax:
Practice Address - Street 1:1329 SW 16TH ST # 4270
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICAL SERVICES
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1128
Practice Address - Country:US
Practice Address - Phone:352-265-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.201559207P00000X
FLME101690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071838Medicaid
FL000577900Medicaid
FLAV397YMedicare PIN
LA4K792DT25Medicare PIN
FL000577900Medicaid
LA4K792DD04Medicare PIN