MEDICARE: DR. ALICIA SLOAN-WEST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		NJ
2	207V00000X	Obstetrics & Gynecology Physician	DR.0071511	CO

General Provider Information

NPI Number	:	1801453790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA SLOAN-WEST MD

Provider Business Mailing Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 400
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3182
Country	:	US
Telephone Number	:	720-652-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 400
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3182
Country	:	US
Telephone Number	:	720-652-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2019
Last Update Date	:	07/05/2023

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