Provider Demographics
NPI:1760828966
Name:RANDALL L. SLOAN, D.O., PLLC
Entity Type:Organization
Organization Name:RANDALL L. SLOAN, D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-456-8434
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0205
Mailing Address - Country:US
Mailing Address - Phone:325-456-8434
Mailing Address - Fax:325-869-5218
Practice Address - Street 1:614 EAKER
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:TX
Practice Address - Zip Code:76837-0987
Practice Address - Country:US
Practice Address - Phone:325-456-8434
Practice Address - Fax:325-869-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2278207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140227301Medicaid
TXA67666Medicare UPIN
TX140227301Medicaid