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General NPI Number Information
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NPI Number | 1770517229
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Entity Type | Organization
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Legal Business Name | CHARLES SLOCUMB M.D.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 2209 COFFEE RD STE M
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-526-8038
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W. GRANGER AVENUE
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-526-3832
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Fax |
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Authorized Official
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Title or Position | OB-GYNECOLOGY
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Name | CHARLES SLOCUMB
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Credential | M.D.
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Telephone | 209-526-3832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C30130
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License Number State | CA
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