Provider Demographics
NPI:1740474428
Name:MATTHEW SLOAN, M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MATTHEW SLOAN, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-427-5409
Mailing Address - Street 1:2650 ELM AVE
Mailing Address - Street 2:108
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1651
Mailing Address - Country:US
Mailing Address - Phone:562-427-5409
Mailing Address - Fax:
Practice Address - Street 1:2650 ELM AVE
Practice Address - Street 2:108
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1651
Practice Address - Country:US
Practice Address - Phone:562-427-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29134207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C291340Medicaid
0655670001Medicare NSC
CA00C291340Medicaid
A33839Medicare UPIN