Healthcare Provider Details

I. General information

NPI: 1396785945
Provider Name (Legal Business Name): MILTON SLOCUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: MILTON SLOCUM M.D.

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 ALBERT L BICKNELL DR STE 3D
SHREVEPORT LA
71103-3903
US

IV. Provider business mailing address

3300 ALBERT L BICKNELL DR
SHREVEPORT LA
71103-3903
US

V. Phone/Fax

Practice location:
  • Phone: 318-635-5151
  • Fax: 318-635-9191
Mailing address:
  • Phone: 318-635-5151
  • Fax: 318-635-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number020179
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: