Provider Demographics
NPI:1578891198
Name:ROBERT E. SLOCUM, D.O.,P.A.
Entity Type:Organization
Organization Name:ROBERT E. SLOCUM, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-691-1224
Mailing Address - Street 1:3314 RANCH DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-4449
Mailing Address - Country:US
Mailing Address - Phone:214-691-1224
Mailing Address - Fax:972-271-1650
Practice Address - Street 1:4925 GREENVILLE AVE
Practice Address - Street 2:SUITE 1158
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4026
Practice Address - Country:US
Practice Address - Phone:214-691-1224
Practice Address - Fax:972-271-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8852208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002222Medicare PIN