Healthcare Provider Details

I. General information

NPI: 1487693982
Provider Name (Legal Business Name): CARLTON DUANE RANDLEMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 20TH ST S STE 100
BIRMINGHAM AL
35209-1924
US

IV. Provider business mailing address

2704 20TH ST S # 100
BIRMINGHAM AL
35209-1924
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-1800
  • Fax:
Mailing address:
  • Phone: 205-592-1800
  • Fax: 205-592-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number16019
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: