Healthcare Provider Details

I. General information

NPI: 1073585402
Provider Name (Legal Business Name): BRENT DREW SLOTEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E BELL RD BLDG 5
PHOENIX AZ
85032-9390
US

IV. Provider business mailing address

4613 E DESERT PARK PL
PARADISE VALLEY AZ
85253-2952
US

V. Phone/Fax

Practice location:
  • Phone: 480-666-5568
  • Fax: 702-297-6238
Mailing address:
  • Phone: 602-909-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: