Provider Demographics
NPI:1053359711
Name:SLABAUGH, DOUGLAS PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:SLABAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22209 SILVERPOINTE LOOP
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5971
Mailing Address - Country:US
Mailing Address - Phone:951-277-8984
Mailing Address - Fax:
Practice Address - Street 1:9080 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1600
Practice Address - Country:US
Practice Address - Phone:562-907-1565
Practice Address - Fax:562-907-1585
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5918207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A5918OtherMEDI-CAL
CA00AX59180Medicaid
W20A5918HMedicare PIN
CAW20A5918IMedicare PIN
CA20A5918OtherMEDI-CAL
CAW20A5918Medicare ID - Type Unspecified