Healthcare Provider Details

I. General information

NPI: 1205228996
Provider Name (Legal Business Name): DUSTIN SLAGLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 940
MIAMI BEACH FL
33140-2890
US

IV. Provider business mailing address

4302 ALTON RD STE 940
MIAMI BEACH FL
33140-2890
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2121
  • Fax:
Mailing address:
  • Phone: 305-674-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME181670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: