MEDICARE: JEFFREY C RANDALL 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	0425975	KS
2	207X00000X	Orthopaedic Surgery Physician	0425975	KS

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467410811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY C RANDALL M.D.

Provider Business Mailing Address
First Line	:	325 MAINE STREET
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66044
Country	:	US
Telephone Number	:	785-505-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	6265 ROCK CHALK DR STE 1500
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-5232
Country	:	US
Telephone Number	:	785-843-9125
Fax Number	:	785-505-5312

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/11/2023

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Directions to “ JEFFREY C RANDALL M.D.” Practice Location

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