Provider Demographics
NPI:1063891570
Name:SLATER, JANTZEN T (MD)
Entity type:Individual
Prefix:
First Name:JANTZEN
Middle Name:T
Last Name:SLATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745
Mailing Address - Country:US
Mailing Address - Phone:479-463-7775
Mailing Address - Fax:479-463-7187
Practice Address - Street 1:199 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-3077
Practice Address - Country:US
Practice Address - Phone:479-267-1001
Practice Address - Fax:479-267-1026
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9865992-1205207Q00000X
ARE-11402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine