Provider Demographics
NPI:1932588811
Name:SLOAN, ERIN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MARIE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 FERRILL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5918
Mailing Address - Country:US
Mailing Address - Phone:405-366-1116
Mailing Address - Fax:
Practice Address - Street 1:1710 W 3RD ST STE 102
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644
Practice Address - Country:US
Practice Address - Phone:580-339-8017
Practice Address - Fax:580-339-8018
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31501390200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200597940AMedicaid