Provider Demographics
NPI:1962499509
Name:SLATE, DUDE (ATC)
Entity Type:Individual
Prefix:MR
First Name:DUDE
Middle Name:
Last Name:SLATE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 N BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-3225
Mailing Address - Country:US
Mailing Address - Phone:505-318-1046
Mailing Address - Fax:505-393-8476
Practice Address - Street 1:205 E BENDER BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2331
Practice Address - Country:US
Practice Address - Phone:505-393-8470
Practice Address - Fax:505-393-8476
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM232174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist