Healthcare Provider Details

I. General information

NPI: 1376561787
Provider Name (Legal Business Name): RANDALL TIBBS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 FRANKLIN ST SE
HUNTSVILLE AL
35801-4301
US

IV. Provider business mailing address

929 FRANKLIN ST SE
HUNTSVILLE AL
35801-4301
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-3624
  • Fax: 256-534-9176
Mailing address:
  • Phone: 256-533-3624
  • Fax: 256-534-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number283
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: