Individual
TRAVIS D SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5475 S 500 E, OGDEN, UT 84405-6905
(800) 880-3566
(801) 733-5872
Mailing address
2740 E 1700 N, LAYTON, UT 84040-7783
(801) 546-6486
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5968724-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107040787101
IHC
UT
01
—
346248
ALTIUS
UT
01
—
6757
HEALTHY U
UT
01
—
68295
PEHP
UT
01
—
908627
DESERET MUTUAL
UT
01
—
QMP000003333370
MOLINA
UT
Enumeration date
08/10/2006
Last updated
07/08/2007
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