# KENNETH DALE SLACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1548375637
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | MD2003-0686 | NM | — |
| 207V00000X | Obstetrics & Gynecology Physician | 2017031964 | MO | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | 44508 | CO | — |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 02/26/2021