Provider Demographics
NPI:1922006063
Name:SLATE, RON E JR (DPM PLLC)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:E
Last Name:SLATE
Suffix:JR
Gender:M
Credentials:DPM PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3923
Mailing Address - Country:US
Mailing Address - Phone:979-848-0777
Mailing Address - Fax:979-849-0757
Practice Address - Street 1:2036 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3923
Practice Address - Country:US
Practice Address - Phone:979-848-0777
Practice Address - Fax:979-849-0757
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1548213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171187104Medicaid
TX5304710001OtherMEDICARE DME PTAN
TX8B8071OtherMEDICARE IND PTAN
TX00528WOtherMEDICARE GROUP PTAN
TX1548OtherTEXAS LICENSE NUMBER
TX152063702Medicaid