Provider Demographics
NPI:1184731531
Name:RON E. SLATE JR DPM PLLC
Entity type:Organization
Organization Name:RON E. SLATE JR DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM PLLC
Authorized Official - Phone:979-848-0777
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8071OtherMEDICARE INDIVIDUAL PTAN
TX00528WOtherMEDICARE GROUP PTAN
TX152063702Medicaid
TX5304710001OtherMEDICARE DME PTAN
TX171187104Medicaid
TXU85120Medicare UPIN