Provider Demographics
NPI:1093850109
Name:SLOAN, LESTER R (PA)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:R
Last Name:SLOAN
Suffix:
Gender:M
Credentials:PA
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 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:6002 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1124
Practice Address - Country:US
Practice Address - Phone:509-482-4402
Practice Address - Fax:509-483-7631
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8383986Medicaid
WAR31442Medicare UPIN
WAG8812516Medicare PIN
WAGAB32944Medicare PIN
WA8383986Medicaid