Provider Demographics
NPI:1073585402
Name:SLOTEN, BRENT DREW (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DREW
Last Name:SLOTEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4880
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-4880
Mailing Address - Country:US
Mailing Address - Phone:480-981-1214
Mailing Address - Fax:480-981-1625
Practice Address - Street 1:1818 E BASELINE RD
Practice Address - Street 2:BLDG A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6814
Practice Address - Country:US
Practice Address - Phone:480-981-1214
Practice Address - Fax:480-981-1625
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3368207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7038351OtherAETNA
AZ685779OtherAHCCCS
AZ685779001OtherAPIPA
AZ3368OtherMEDICAL LICENSE
AZ685779001OtherMERCY CARE
AZAZ0768700OtherBCBS
AZ2Z1930OtherHEALTHNET
AZ685779001OtherAPIPA