Individual
DR. MICHAEL TEDFORD SLAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 S KANNER HWY STE 200, STUART, FL 34994-4801
(772) 219-4026
(772) 283-4919
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME93774
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273640300
—
FL
01
—
28685
BLUE SHIELD OF FL PROV #
FL
Enumeration date
04/19/2006
Last updated
10/13/2020
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