Provider Demographics
NPI:1619964061
Name:SLABAUGH, DOREEN ANN (DO)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:ANN
Last Name:SLABAUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:ANN
Other - Last Name:TRAINA-PENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:3120 CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7131
Practice Address - Country:US
Practice Address - Phone:928-771-3704
Practice Address - Fax:928-771-0434
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957962Medicaid
AZ957962-01Medicaid
AZ106173Medicare UPIN