Provider Demographics
NPI:1164082459
Name:SLOAN, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SLOAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15042 W 106TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2052
Mailing Address - Country:US
Mailing Address - Phone:816-599-7001
Mailing Address - Fax:816-278-9153
Practice Address - Street 1:15042 W 106TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2052
Practice Address - Country:US
Practice Address - Phone:816-599-7001
Practice Address - Fax:816-278-9153
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO25476190332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies