Provider Demographics
NPI:1578570578
Name:SLAGLE, DODGE ALAN (DO)
Entity Type:Individual
Prefix:
First Name:DODGE
Middle Name:ALAN
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1070 WIGWAM PARKWAY
Mailing Address - Street 2:#100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-454-0201
Mailing Address - Fax:702-454-1245
Practice Address - Street 1:1070 WIGWAM PARKWAY
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-454-0201
Practice Address - Fax:702-454-1245
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002729Medicaid
NVV104057Medicare PIN
NV002002729Medicaid