Provider Demographics
NPI:1245387240
Name:MATT SLOAN MD PLLC
Entity Type:Organization
Organization Name:MATT SLOAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-458-3872
Mailing Address - Street 1:PO BOX 670367
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367
Mailing Address - Country:US
Mailing Address - Phone:469-458-3872
Mailing Address - Fax:469-458-3895
Practice Address - Street 1:12800 HILLCREST RD, SUITE A123
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:469-326-0014
Practice Address - Fax:469-326-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5619207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X724Medicare PIN