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Individual

JASON BRYANT SLADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
9850 ST LUKES DR, NAMPA, ID 83687-7912
(208) 505-5200
Mailing address
705 RILEY HOSPITAL DR RM 5867, INDIANAPOLIS, IN 46202-5109
(217) 819-2137

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-12906
ID
208000000X
Pediatrics Physician
M-12906
ID

Other

Enumeration date
04/28/2011
Last updated
07/21/2022
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