Provider Demographics
NPI:1972672269
Name:SLONAKER, DANIEL A
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:SLONAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:1001 NORTH MAIN AVENUE
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-0499
Mailing Address - Country:US
Mailing Address - Phone:423-743-9176
Mailing Address - Fax:423-743-0860
Practice Address - Street 1:1001 NORTH MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-0499
Practice Address - Country:US
Practice Address - Phone:423-743-9176
Practice Address - Fax:423-743-0860
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000012214207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714636Medicaid
B04365Medicare UPIN
TN3714636Medicaid