Individual
DR. KENNETH VERNON SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7727 LAKE UNDERHILL RD, ORLANDO, FL 32822-8224
(407) 303-6413
Mailing address
7727 LAKE UNDERHILL RD, ORLANDO, FL 32822-8224
(407) 303-6413
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME119973
FL
207P00000X
Emergency Medicine Physician
TRN18079
FL
208600000X
Surgery Physician
24792
NE
Other
Enumeration date
10/10/2008
Last updated
04/06/2020
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