Individual
SAM WILLDEN SLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3269 N STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-0649
Mailing address
2611 DIAMOND SPUR ST, KINGMAN, AZ 86401-7323
(702) 300-0628
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
007800
AZ
207P00000X
Emergency Medicine Physician
Primary
CDR.0001413
CO
Other
Enumeration date
02/09/2017
Last updated
12/29/2021
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