Provider Demographics
NPI:1780640318
Name:SLEDGE, GEORGE W JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:SLEDGE
Suffix:JR
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 1:269 CAMPUS DR
Mailing Address - Street 2:ADMINISTRATIVE OFFICE: CCSR 1115
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DRIVE
Practice Address - Street 2:MC 5500
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5500
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032928207RH0003X
CAC55993207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100074080Medicaid
IN264910I5Medicare PIN
IN100074080Medicaid