Provider Demographics
NPI:1316943731
Name:SLOCUM, CARL W (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:SLOCUM
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 1:5 SHERIDAN SQ
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7390
Mailing Address - Country:US
Mailing Address - Phone:423-246-8155
Mailing Address - Fax:423-246-8658
Practice Address - Street 1:5 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7390
Practice Address - Country:US
Practice Address - Phone:423-246-8155
Practice Address - Fax:423-246-8658
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9416207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006500421Medicaid
TN3158696Medicaid
TN3158696Medicare ID - Type Unspecified
VA006500421Medicaid