Provider Demographics
NPI:1770650657
Name:SLATER, DANIEL R (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:SLATER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 W. ARBOR DRIVE
Mailing Address - Street 2:UCSD MEDICAL CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8821
Mailing Address - Country:US
Mailing Address - Phone:619-543-7838
Mailing Address - Fax:619-543-7850
Practice Address - Street 1:9333 GENESEE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2113
Practice Address - Country:US
Practice Address - Phone:858-657-8600
Practice Address - Fax:858-657-8625
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G641470Medicaid
CA00G641470Medicaid