Provider Demographics
NPI:1598997819
Name:SLAGLEY, BRANDON BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:BLAKE
Last Name:SLAGLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45 MEDICAL ARTS CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3871
Mailing Address - Country:US
Mailing Address - Phone:334-382-1632
Mailing Address - Fax:334-382-1634
Practice Address - Street 1:45 MEDICAL ARTS CT
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3871
Practice Address - Country:US
Practice Address - Phone:334-382-1632
Practice Address - Fax:334-382-1634
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALL3084R207Q00000X
ALMD.30550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-27803OtherBCBS
AL141369Medicaid
1871003533OtherGROUP NPI
ALP01082168OtherRAILROAD MEDICARE
AL529906610 GROUPMedicaid
AL529906610 GROUPMedicaid
AL102I082504Medicare PIN