Provider Demographics
NPI:1619964061
Name:SLABAUGH, DOREEN ANN (DO)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:ANN
Last Name:SLABAUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:ANN
Other - Last Name:TRAINA-PENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:300 N LEE BLVD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5710
Practice Address - Country:US
Practice Address - Phone:928-708-4300
Practice Address - Fax:928-458-2122
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957962Medicaid
AZ957962-01Medicaid
AZ106173Medicare UPIN