Provider Demographics
NPI:1629619820
Name:SLAVEN, JON (PA-C)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:SLAVEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MIDWAY MEDICAL PARK STE 100
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1722
Mailing Address - Country:US
Mailing Address - Phone:423-968-4446
Mailing Address - Fax:423-844-6733
Practice Address - Street 1:260 MIDWAY MEDICAL PARK STE 100
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1722
Practice Address - Country:US
Practice Address - Phone:423-968-4446
Practice Address - Fax:423-844-6733
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3977207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery