Provider Demographics
NPI:1942497466
Name:SLATER, JAMES JONATHAN (DO)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JONATHAN
Last Name:SLATER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2611 CHARLEVOIX AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8524
Mailing Address - Country:US
Mailing Address - Phone:231-348-5900
Mailing Address - Fax:231-348-5901
Practice Address - Street 1:2611 CHARLEVOIX AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8524
Practice Address - Country:US
Practice Address - Phone:231-348-5900
Practice Address - Fax:231-348-5901
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015870207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4832946-11Medicaid
MI0451601125OtherBCBS
MI1356394803OtherNPI, NORTHWOODS ENT
0P26930-001Medicare PIN
MI4832946-11Medicaid