Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | C30130 | CA |
NPI | 1295817245 |
---|---|
Provider Name | Charles Slocumb |
First Address | Modesto, CA 95350-4572 |
Second Address | Modesto, CA 95350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 28/03/2020 |