C. Lawrence Slade, M.d., F.a.c.s., LLC

NPI #1578836003 in Port Orange, Florida

Provider Information

NPI Number: 1578836003
Entity Type: Organization
Organization Name: C. Lawrence Slade, M.d., F.a.c.s., LLC
Primary Specialty: Specialist
Enumeration Date: Feb 14, 2012
Last Updated: Mar 22, 2012

Practice Location

Address: 3635 S CLYDE MORRIS BLVD
Address 2: SUITE 400
City: Port Orange
State: Florida
ZIP Code: 32129-2300
Phone: (386) 756-9400

Authorized Official

Name: CLEMENT L SLADE, M.D.
Title: PRESIDENT
Phone: (386) 756-9400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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