Provider Demographics
NPI:1477638807
Name:SLOOP, JAY RANDAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:RANDAL
Last Name:SLOOP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2068 TALBERT DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7723
Mailing Address - Country:US
Mailing Address - Phone:530-809-0009
Mailing Address - Fax:809-809-0399
Practice Address - Street 1:5974 PENTZ RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5509
Practice Address - Country:US
Practice Address - Phone:530-342-5776
Practice Address - Fax:530-898-0178
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61004207R00000X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH55871Medicare PIN
GUE75741Medicare UPIN