Provider Demographics
NPI:1629009998
Name:SLOAN, TERRANCE W (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:W
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E. NIZHONI BLVD
Mailing Address - Street 2:BOX 1337
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-1337
Mailing Address - Country:US
Mailing Address - Phone:505-722-1000
Mailing Address - Fax:505-726-8557
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:BOX 1337
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-726-8557
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM76-270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ419483Medicaid
NM000S0878Medicaid
H45150Medicare UPIN
TX8HZ447Medicare ID - Type UnspecifiedHSZ003
TX8HZ896Medicare ID - Type UnspecifiedHSZ001
AZ419483Medicaid
NM000S0878Medicaid
TX8HZ41AMedicare ID - Type UnspecifiedHSZ002
TX8HZ31AMedicare ID - Type UnspecifiedHSZ005