Provider Demographics
NPI:1912039231
Name:SLATER, KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:SLATER
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 1:10600 CHEVROLET WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-4421
Mailing Address - Country:US
Mailing Address - Phone:239-287-0576
Mailing Address - Fax:
Practice Address - Street 1:10600 CHEVROLET WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-4421
Practice Address - Country:US
Practice Address - Phone:239-287-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 699322084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28615OtherBLUE CROSS