NPI 1386141539

Stephen Daniel Slack

Practitioner Contractor Shreveport, LA

Practice location

Address: 458 W 61st St, Shreveport, LA 71106-2511
Phone: (318) 510-1141

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1386141539
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Apr 2018
Record last updated: 12 Apr 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.