Provider Demographics
NPI:1861814386
Name:SLECKMAN, BETHANY (MD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:SLECKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 3425
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8222
Mailing Address - Country:US
Mailing Address - Phone:314-251-7057
Mailing Address - Fax:314-251-5665
Practice Address - Street 1:607 S NEW BALLAS RD
Practice Address - Street 2:SUITE 3425
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8222
Practice Address - Country:US
Practice Address - Phone:314-251-7057
Practice Address - Fax:314-251-5665
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002027895207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology