Healthcare Provider Details

I. General information

NPI: 1902862527
Provider Name (Legal Business Name): RAYMOND J SLOAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EASTSIDE RD
PLATTEVILLE WI
53818-9800
US

IV. Provider business mailing address

1400 EASTSIDE RD
PLATTEVILLE WI
53818-9800
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-4330
  • Fax: 608-342-4801
Mailing address:
  • Phone: 608-348-4330
  • Fax: 608-342-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19553-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: