1942282868 NPI number — JOHN EDWARD SLAYDEN M.D.

Table of content: JOHN EDWARD SLAYDEN M.D. (NPI 1942282868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942282868 NPI number — JOHN EDWARD SLAYDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLAYDEN
Provider First Name:
JOHN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLAYDEN
Provider Other First Name:
JOHN
Provider Other Middle Name:
EDWARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1942282868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 TREE TOPS LN APT 701
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72202-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-661-0858
Provider Business Mailing Address Fax Number:
501-907-4751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 CARTI WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-219-8777
Provider Business Practice Location Address Fax Number:
501-907-6522
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  C-4054 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110562001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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