Provider Demographics
NPI:1073602900
Name:SLOAN, RANDY M (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:M
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2421 SILVER STREAM LN
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7684
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-8824
Practice Address - Street 1:1899 N MARINE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6555
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-8824
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9501103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2332257Medicaid
NCG10225Medicare UPIN
NC2215969DMedicare PIN