Provider Demographics
NPI:1437111887
Name:SLOAN, RANDALL LEE (DO)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:SLOAN
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 1:341 W H ST
Mailing Address - Street 2:
Mailing Address - City:MUNDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76371-1977
Mailing Address - Country:US
Mailing Address - Phone:302-385-6668
Mailing Address - Fax:
Practice Address - Street 1:341 W H ST
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371-1977
Practice Address - Country:US
Practice Address - Phone:302-385-6668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-06-29
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-14
Provider Licenses
StateLicense IDTaxonomies
TXG2278207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140227301Medicaid
TXA67666Medicare UPIN
TX00071GMedicare UPIN