Provider Demographics
NPI:1194778951
Name:SLATER, WILLIAM M (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:SLATER
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 1:1908 N 14TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2039
Mailing Address - Country:US
Mailing Address - Phone:580-718-4506
Mailing Address - Fax:580-762-3420
Practice Address - Street 1:201 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-6117
Practice Address - Country:US
Practice Address - Phone:620-872-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420362208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS020037172OtherRAILROAD MEDICARE
KS100177090BMedicaid
KS100177090BMedicaid
KS100177090BMedicaid
KSD42825Medicare UPIN