Provider Demographics
NPI:1619484615
Name:MARTIN V SLOAN DPM
Entity Type:Organization
Organization Name:MARTIN V SLOAN DPM
Other - Org Name:LAKE POINTE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:325-695-1890
Mailing Address - Street 1:1150 N 18TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2931
Mailing Address - Country:US
Mailing Address - Phone:325-695-1890
Mailing Address - Fax:
Practice Address - Street 1:6800 HERITAGE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8746
Practice Address - Country:US
Practice Address - Phone:972-412-9400
Practice Address - Fax:972-412-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty