Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 22621 | MS |
N | 207Q00000X | Family Doctor | OS10752 | FL |
NPI | 1669705372 |
---|---|
Provider Name | Dr. Richard Gray Sloan JR. |
First Address | Hattiesburg, MS 39401-5461 |
Second Address | Hattiesburg, MS 39401-5461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2009 |
Last Update Date | 29/07/2013 |