Provider Demographics
NPI:1720100803
Name:SLATER, JARED M (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:M
Last Name:SLATER
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:PO BOX 100286
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0286
Mailing Address - Country:US
Mailing Address - Phone:352-265-0761
Mailing Address - Fax:352-265-1060
Practice Address - Street 1:1451 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-0041
Practice Address - Country:US
Practice Address - Phone:352-265-0761
Practice Address - Fax:352-265-1060
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME154203208600000X
MN49862208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00888769OtherMEDICARE, RAILROAD
MN024490000Medicaid
MN020002940Medicare PIN
MN024490000Medicaid