Healthcare Provider Details

I. General information

NPI: 1245232974
Provider Name (Legal Business Name): STEVEN J. SLAGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643 WAIMEA CANYON DR.
WAIMEA HI
96796-0337
US

IV. Provider business mailing address

PO BOX 337 4643 WAIMEA CANYON DR.
WAIMEA HI
96796-0337
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-5282
  • Fax: 808-338-9210
Mailing address:
  • Phone: 808-652-5282
  • Fax: 808-338-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG0127
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG0127
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD 15810
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: