Randy D Sorum, MD | |
3920 Capital Mall Dr Sw Ste 100b, Olympia, WA 98502-8186 | |
(360) 596-4872 | |
(253) 627-8792 |
Full Name | Randy D Sorum |
---|---|
Gender | Male |
Speciality | Radiology - Radiation Oncology |
Location | 3920 Capital Mall Dr Sw Ste 100b, Olympia, Washington |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720059181 | NPI | - | NPPES |
8206898 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2085R0001X | Radiology - Radiation Oncology | MD00034810 (Washington) | Primary |
Entity Name | Peninsula Rad Onc Ctr Llc |
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Entity Type | Part B Supplier - Radiation Therapy Center |
Entity Identifiers | NPI Number: 1366694796 PECOS PAC ID: 6204990450 Enrollment ID: O20090203000240 |
Mailing Address | Practice Location Address |
---|---|
Randy D Sorum, MD 4230 Bridgeport Way W Ste B, University Place, WA 98466-4335 Ph: (253) 779-6325 | Randy D Sorum, MD 3920 Capital Mall Dr Sw Ste 100b, Olympia, WA 98502-8186 Ph: (360) 596-4872 |
Dr. Kevin Joseph Reed, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4609 Fax: 360-493-4603 | |
Dr. Lawrence Northwood Bennett, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Samuel J. Boynton, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Tariq Hesham Balawi, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Jabi Elijah Shriki, M.D. Radiology Medicare: Not Enrolled in Medicare Practice Location: 3417 Ensign Road Ne, Olympia, WA 98506 Phone: 360-493-4609 Fax: 360-493-4603 | |
Dr. Jack Mark Fields, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 3417 Ensign Rd Ne, Olympia, WA 98506 Phone: 360-493-4600 Fax: 360-493-4603 | |
Dr. Christopher Brinson Hartness, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 413 Lilly Rd Ne, Olympia, WA 98506 Phone: 604-937-4603 Fax: 360-493-7253 |