Provider Demographics
NPI:1881699437
Name:SLONIM, SAMUEL L (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:SLONIM
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 1:34616 11TH PL S # 5
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8705
Mailing Address - Country:US
Mailing Address - Phone:253-927-6500
Mailing Address - Fax:253-952-7280
Practice Address - Street 1:34616 11TH PL S # 5
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8705
Practice Address - Country:US
Practice Address - Phone:253-927-6500
Practice Address - Fax:253-952-7280
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASLO250OtherREGENCE PROVIDER ID
WA1004985Medicaid
A05648Medicare UPIN