Provider Demographics
NPI:1275889826
Name:SLOCUM, PHILIP (DO)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:DO
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8315
Mailing Address - Fax:
Practice Address - Street 1:1111 MCINTOSH CIR
Practice Address - Street 2:STE 302
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3615
Practice Address - Country:US
Practice Address - Phone:417-347-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200200143207RC0200X, 207RP1001X, 207RS0012X
TX44373207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8ED501OtherBCBS
TXP01447536OtherRAILROAD MEDICARE
TX329061101Medicaid
TX8ED501OtherBCBS