Provider Demographics
NPI:1386472124
Name:SLOCUM, GARALD
Entity type:Individual
Prefix:MR
First Name:GARALD
Middle Name:
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 CHAMPAIGN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8322
Mailing Address - Country:US
Mailing Address - Phone:614-615-7872
Mailing Address - Fax:
Practice Address - Street 1:7950 CHAMPAIGN DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8322
Practice Address - Country:US
Practice Address - Phone:614-615-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver