Individual
MR. MALCOLM WALTON SLATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1014 PRIMROSE AVE, LONGMONT, CO 80301
(303) 704-6504
(720) 652-4774
Mailing address
5704 CAPISTRANO WAY, FREDERICK, CO 80504-9712
(303) 704-6504
(720) 652-4774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
919
CO
363AM0700X
Medical Physician Assistant
103150
NC
363AM0700X
Medical Physician Assistant
212
IL
363AM0700X
Medical Physician Assistant
521
SC
363AM0700X
Medical Physician Assistant
Primary
919
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103150
STATE LICENSE
NC
01
—
212
STATE LICENSE
IL
01
—
521
STATE LICENSE
SC
05
—
87986710
—
CO
01
—
919
STATE LICENSE
CO
Enumeration date
09/15/2005
Last updated
09/06/2013
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