Provider Demographics
NPI:1407842917
Name:SLAGLE, GREGORY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
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 1:519 FILES RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7264
Mailing Address - Country:US
Mailing Address - Phone:150-162-5724
Mailing Address - Fax:501-625-3071
Practice Address - Street 1:519 FILES RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7264
Practice Address - Country:US
Practice Address - Phone:501-625-7246
Practice Address - Fax:501-625-3071
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4262207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121643001Medicaid
AR55541OtherAR BCBS
P00278297OtherRR MEDICARE GROUP CK6327
F27712Medicare UPIN
AR55541C752Medicare PIN
AR121643001Medicaid