Provider Demographics
NPI:1780873356
Name:JOHN B. SLAYBACK, M.D., INC.
Entity type:Organization
Organization Name:JOHN B. SLAYBACK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SLAYBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-793-3760
Mailing Address - Street 1:355 TERRACINA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4819
Mailing Address - Country:US
Mailing Address - Phone:909-793-3760
Mailing Address - Fax:909-335-8625
Practice Address - Street 1:355 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4819
Practice Address - Country:US
Practice Address - Phone:909-793-3760
Practice Address - Fax:909-335-8625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN B. SLAYBACK, M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA217572086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245302223OtherINDIVIDUAL NPI
CAZZZ03213Medicare PIN
CAA22759Medicare UPIN