Provider Demographics
NPI:1891371316
Name:SLAGLE, GRANT THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:THOMAS
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2611 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3907
Mailing Address - Country:US
Mailing Address - Phone:318-212-2020
Mailing Address - Fax:318-212-6336
Practice Address - Street 1:2611 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3907
Practice Address - Country:US
Practice Address - Phone:318-212-2020
Practice Address - Fax:318-212-6336
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA346421207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology