Provider Demographics
NPI:1699867366
Name:SHARLET SLOUGH DO
Entity type:Organization
Organization Name:SHARLET SLOUGH DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARLET
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-617-6239
Mailing Address - Street 1:PO BOX 8819
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8819
Mailing Address - Country:US
Mailing Address - Phone:903-617-6239
Mailing Address - Fax:903-617-6249
Practice Address - Street 1:6115 NEW COPELAND RD STE 240
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-617-6239
Practice Address - Fax:903-617-6249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG2129OtherRAILROAD MEDICARE PIN
TX0055PWOtherBCBS
TX185213901Medicaid
TX185213901Medicaid