Slate Medical Aesthetics PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SLATE MEDICAL AESTHETICS PLLC

Practice address

920 Deon Dr Ste a
Pocatello, ID 83201-3069

Phone

(208) 904-0217

NPI assigned

Nov 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy R Monroe, DO

Title

Owner

Phone

(208) 904-0217

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1386419273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 DEON DR STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013069",
            "telephone_number": "208-904-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 DEON DR STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013069",
            "telephone_number": "208-904-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLATE MEDICAL AESTHETICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-20",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "MONROE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-904-0217",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.