Provider Demographics
NPI:1396785945
Name:SLOCUM, MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MILTON
Other - Middle Name:
Other - Last Name:SLOCUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3300 ALBERT L BICKNELL DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3903
Mailing Address - Country:US
Mailing Address - Phone:318-635-5151
Mailing Address - Fax:318-635-9191
Practice Address - Street 1:3300 ALBERT L BICKNELL DR STE 3D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3903
Practice Address - Country:US
Practice Address - Phone:318-635-5151
Practice Address - Fax:318-635-9191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0201792086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548570Medicaid
LA1548570Medicaid
LA5H502Medicare ID - Type Unspecified