Individual
KENNETH DALE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 339-1166
(573) 339-7166
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-5583
(573) 331-5079
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD2003-0686
NM
207V00000X
Obstetrics & Gynecology Physician
Primary
2017031964
MO
207V00000X
Obstetrics & Gynecology Physician
44508
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41035259
—
NM
05
—
86081039
—
CO
Enumeration date
08/20/2006
Last updated
02/26/2021
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