Individual
DR. CHRISTOPHER LEE SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4632 S 25TH ST, FORT PIERCE, FL 34981-5057
(772) 464-9595
(772) 464-9582
Mailing address
4632 S 25TH ST, FORT PIERCE, FL 34981-5057
(772) 464-9595
(772) 464-9582
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
36380
CO
207YS0123X
Facial Plastic Surgery Physician
Primary
ME84369
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264157700
—
FL
Enumeration date
08/08/2006
Last updated
07/09/2010
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