Provider Demographics
NPI:1528076999
Name:SLOAN, CHARLES MATTESON JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MATTESON
Last Name:SLOAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:SLOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 670367
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367
Mailing Address - Country:US
Mailing Address - Phone:469-458-3872
Mailing Address - Fax:469-458-3895
Practice Address - Street 1:3901 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7738
Practice Address - Country:US
Practice Address - Phone:469-326-0014
Practice Address - Fax:469-326-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5619207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L14366Medicare PIN
TX8L14365Medicare PIN
TXD69093Medicare UPIN
TX8B0212Medicare ID - Type Unspecified
TX8L14364Medicare PIN