Provider Demographics
NPI:1770580169
Name:SLABBERT, CHRISTIAAN JOHANNES (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAAN
Middle Name:JOHANNES
Last Name:SLABBERT
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 1:8600 S 36TH TER
Mailing Address - Street 2:STE A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8768
Mailing Address - Country:US
Mailing Address - Phone:479-709-7465
Mailing Address - Fax:479-709-7466
Practice Address - Street 1:7320 ROGERS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4164
Practice Address - Country:US
Practice Address - Phone:479-452-6362
Practice Address - Fax:479-484-5652
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5L903Medicare ID - Type Unspecified
ARH38081Medicare UPIN