Provider Demographics
NPI:1043282957
Name:BLAIR, SLOANE ROXANNE (MD)
Entity Type:Individual
Prefix:
First Name:SLOANE
Middle Name:ROXANNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0785
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:110 NW 31ST STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73502-0785
Practice Address - Country:US
Practice Address - Phone:916-681-8900
Practice Address - Fax:916-720-0306
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87085207XS0117X
NDPT14297207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G870850Medicaid
CA00G870850Medicare ID - Type Unspecified
CA00G870850Medicaid