MEDICARE: HOOD RIVER DERMATOLOGY, INC

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

General Provider Information

NPI Number	:	1962683839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOD RIVER DERMATOLOGY, INC

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	:	OWNER
Name	:	DR. LUKE B SLOAN
Credential	:	M.D.
Telephone Number	:	541-386-2517

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	10/01/2015

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