Provider Demographics
NPI:1972619492
Name:SLAVIN, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SLAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 KANE CONCOURSE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2029
Mailing Address - Country:US
Mailing Address - Phone:305-865-4000
Mailing Address - Fax:305-531-1123
Practice Address - Street 1:1111 KANE CONCOURSE
Practice Address - Street 2:SUITE 111
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2029
Practice Address - Country:US
Practice Address - Phone:305-865-4000
Practice Address - Fax:305-531-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0012160207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052527800Medicaid
FL245560OtherAVMED
FL052527800Medicaid
FL91386Medicare ID - Type Unspecified