Provider Demographics
NPI:1639178387
Name:SLOAN, MARTIN VAN (DPM)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:VAN
Last Name:SLOAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 18TH ST
Mailing Address - Street 2:STE 206
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:325-695-1665
Practice Address - Street 1:1150 N 18TH ST
Practice Address - Street 2:STE 206
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-695-1890
Practice Address - Fax:325-695-1665
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPD872213EP1101X, 213ES0103X
TX0872213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004395004OtherAETNA
TX00FJ64OtherBLUE CROSS BLUE SHIELD
TX0187064-01Medicaid
TX0288250001OtherDMERC NSC
TX0288250002OtherDMERC NSC ROCKWALL
TX124202100OtherFIRSTCARE
TX480004770OtherRAILROAD MEDICARE
TX00FJ64OtherBLUE CROSS BLUE SHIELD