Basic Information
Provider Information | |||||||||
NPI: | 1003835612 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SLAUGHTER | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 850 PETER BRYCE BLVD | ||||||||
Address2: |   | ||||||||
City: | TUSCALOOSA | ||||||||
State: | AL | ||||||||
PostalCode: | 354017419 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2053481770 | ||||||||
FaxNumber: | 2053485145 | ||||||||
Practice Location | |||||||||
Address1: | 850 PETER BRYCE BLVD | ||||||||
Address2: |   | ||||||||
City: | TUSCALOOSA | ||||||||
State: | AL | ||||||||
PostalCode: | 35401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2053481770 | ||||||||
FaxNumber: | 2053485145 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2006 | ||||||||
LastUpdateDate: | 07/25/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD12825 | AL | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 2084N0400X | 12825 | AL | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
ID | Type | State | Issuer | Description | 000005851 | 05 | AL |   | MEDICAID | 124901 | 01 | MS | MISSISSIPPI MEDICAID | OTHER | C70405 | 01 | AL | VIVA | OTHER | 000036861 | 05 | AL |   | MEDICAID | 051504057 | 01 | AL | BLUE CROSS | OTHER | 000005851 | 01 | AL | BLUE CROSS | OTHER | 000013437 | 01 | AL | HEALTHSPRING OF ALABAMA | OTHER | 000013438 | 01 | AL | HEALTHSPRING OF ALABAMA | OTHER | 000036861 | 01 | AL | BLUE CROSS | OTHER |