Healthcare Provider Details

I. General information

NPI: 1578556775
Provider Name (Legal Business Name): CHRISTOPHER SLOAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W LIBERTY ST STE 4050A
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

1103 W LIBERTY ST
FARMINGTON MO
63640-1986
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6751
  • Fax:
Mailing address:
  • Phone: 573-756-7779
  • Fax: 573-756-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00698
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: