Provider Demographics
NPI:1124128954
Name:SLOAN, RICK MICHAEL WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:MICHAEL WESLEY
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-6541
Mailing Address - Country:US
Mailing Address - Phone:623-773-2273
Mailing Address - Fax:623-773-2274
Practice Address - Street 1:7615 W THUNDERBIRD RD
Practice Address - Street 2:STE 106
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6083
Practice Address - Country:US
Practice Address - Phone:623-773-2273
Practice Address - Fax:623-773-2274
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ948664Medicaid
AZI35391Medicare UPIN
AZZ90023Medicare PIN
AZ8HE103 PART BMedicare ID - Type Unspecified
AZ948664Medicaid
AZZ142020Medicare PIN