Provider Demographics
NPI:1043347818
Name:SLIGHTAM, JOHN D (MD,)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:SLIGHTAM
Suffix:
Gender:M
Credentials:MD,
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Mailing Address - Street 1:19987 1ST AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2400
Mailing Address - Country:US
Mailing Address - Phone:206-824-5554
Mailing Address - Fax:206-824-5550
Practice Address - Street 1:19987 1ST AVE S
Practice Address - Street 2:SUITE 101
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2400
Practice Address - Country:US
Practice Address - Phone:206-824-5554
Practice Address - Fax:206-824-5550
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2012-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAWA000282912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1070028Medicaid
WAA82915Medicare UPIN
WAG000108644Medicare ID - Type Unspecified