MEDICARE: SONJA L. RANDLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	H0748	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073595161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA L. RANDLE M.D.

Provider Business Mailing Address
First Line	:	4606 FM 1960 RD W
Second Line	:	SUITE 545
City	:	HOUSTON
State	:	TX
Zip	:	77069-4600
Country	:	US
Telephone Number	:	281-639-3024
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 FM 1960 RD W
Second Line	:	SUITE 545
City	:	HOUSTON
State	:	TX
Zip	:	77069-4600
Country	:	US
Telephone Number	:	281-639-3024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/15/2011

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