MEDICARE: LUKE B SLOAN 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	207NS0135X	Procedural Dermatology Physician	MD22481	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070015619	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	879128001	OTHER	OR	BLUE CROSS BLUE SHIELD
2	1018614	OTHER		CHPW/WA DSHS

General Provider Information

NPI Number	:	1598862542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE B SLOAN MD

Provider Business Mailing Address
First Line	:	917 11TH ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1578
Country	:	US
Telephone Number	:	541-386-2517
Fax Number	:	541-386-1919

Provider Business Practice Location Address
First Line	:	917 11TH ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1578
Country	:	US
Telephone Number	:	541-386-2517
Fax Number	:	541-386-1919

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/01/2015

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Directions to “ LUKE B SLOAN MD” Practice Location

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