Provider Demographics
NPI:1154387108
Name:SLOAN, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 ELM AVE
Mailing Address - Street 2:108
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1651
Mailing Address - Country:US
Mailing Address - Phone:562-427-5409
Mailing Address - Fax:562-426-6321
Practice Address - Street 1:2650 ELM AVE
Practice Address - Street 2:108
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1651
Practice Address - Country:US
Practice Address - Phone:562-427-5409
Practice Address - Fax:562-426-6321
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC29134207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC29134Medicaid
A33839Medicare UPIN
CAOOC29134Medicaid
0655670001Medicare NSC