Provider Demographics
NPI:1588665228
Name:SLOAN, LANCE A (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:A
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152837
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-2837
Mailing Address - Country:US
Mailing Address - Phone:936-462-7844
Mailing Address - Fax:936-462-7855
Practice Address - Street 1:10 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3173
Practice Address - Country:US
Practice Address - Phone:936-632-4282
Practice Address - Fax:936-632-4249
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0822207RE0101X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390002117OtherRAILROAD MEDICARE
TX136236010Medicaid
TX136236011OtherCIDC/CSN
TX8BF246OtherBLUE CROSS BLUE SHIELD
TX8F20850Medicare PIN
TX00365YMedicare PIN
TX136236004OtherCIDC
TX136236008Medicaid
TXF05852Medicare UPIN
TX136236010Medicaid
TX00J89BMedicare PIN
TX8F20850Medicare PIN
TX00J89BOtherPIN
TX136236004Medicaid
TX8BF246OtherBLUE CROSS BLUE SHIELD
TX136236011Medicaid