Basic Information
| Provider Information | |||||||||
| NPI: | 1700973831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLAVEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | STUART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 FRANKLIN ST SE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565399471 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2006 FRANKLIN ST SE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565399471 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 31212 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 511-55929 | 01 | AL | BLUE SHIELD ALABAMA | OTHER | 511-55928 | 01 | AL | BLUE SHIELD ALABAMA | OTHER | 511-55927 | 01 | AL | BLUE SHIELD ALABAMA | OTHER |