Provider Demographics
NPI:1073585402
Name:SLOTEN, BRENT DREW (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:DREW
Last Name:SLOTEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 E DESERT PARK PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2952
Mailing Address - Country:US
Mailing Address - Phone:602-909-1237
Mailing Address - Fax:
Practice Address - Street 1:4550 E BELL RD BLDG 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9390
Practice Address - Country:US
Practice Address - Phone:480-666-5568
Practice Address - Fax:702-297-6238
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3368207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7038351OtherAETNA
AZ685779OtherAHCCCS
AZ685779001OtherAPIPA
AZ3368OtherMEDICAL LICENSE
AZ685779001OtherMERCY CARE
AZAZ0768700OtherBCBS
AZ2Z1930OtherHEALTHNET
AZ685779001OtherAPIPA