Provider Demographics
NPI:1245232974
Name:SLAGLE, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:4643 WAIMEA CANYON DR.
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0337
Mailing Address - Country:US
Mailing Address - Phone:808-652-5282
Mailing Address - Fax:808-338-9210
Practice Address - Street 1:4643 WAIMEA CANYON DR.
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796-0337
Practice Address - Country:US
Practice Address - Phone:808-652-5282
Practice Address - Fax:808-338-9210
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0127207R00000X, 208M00000X
HIMD 15810208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L40POtherBC/BS
TX099301604Medicaid
TX099301602Medicaid
TX8W2430OtherBC/BS
TX00L40POtherBC/BS
TX8F4308Medicare PIN
TX099301602Medicaid