Provider Demographics
NPI:1013014745
Name:SLATER, CRISTIN C (MD)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:C
Last Name:SLATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:
Other - Last Name:COULAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 MAIN ST
Mailing Address - Street 2:#100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7307
Mailing Address - Country:US
Mailing Address - Phone:208-342-5900
Mailing Address - Fax:208-342-2088
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:#100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7307
Practice Address - Country:US
Practice Address - Phone:208-342-5900
Practice Address - Fax:208-342-2088
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8614207VE0102X
CAG81581207VE0102X
UT61941811205207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID51292OtherBLUE CROSS
ID51292OtherBLUE CROSS