Provider Demographics
NPI:1720059181
Name:SORUM, RANDY D (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:SORUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1733
Mailing Address - Country:US
Mailing Address - Phone:712-252-9372
Mailing Address - Fax:712-252-9327
Practice Address - Street 1:230 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1733
Practice Address - Country:US
Practice Address - Phone:712-252-9372
Practice Address - Fax:712-252-9327
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000348102085R0001X
IAMD-497062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8206898Medicaid
WA8206898Medicaid