Provider Demographics
NPI:1356546774
Name:SLATER, LEIGH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:SLATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:250 BICENTENNIAL WAY APT 711
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7421
Mailing Address - Country:US
Mailing Address - Phone:707-230-1534
Mailing Address - Fax:707-303-7394
Practice Address - Street 1:1165 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4897
Practice Address - Country:US
Practice Address - Phone:707-230-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134762208600000X, 2086S0127X, 2086S0102X
MDD74206208600000X, 2086S0102X, 2086S0127X
NMMD2015-01462086S0102X
NMCS002214532086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055296800Medicaid
MD055296800Medicaid