Healthcare Provider Details

I. General information

NPI: 1528085347
Provider Name (Legal Business Name): RANDY DOUGLAS PROFFITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RANDY DOUGLAS PROFFITT M.D.

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 PICCADILLY SQUARE DR
MOBILE AL
36609-5103
US

IV. Provider business mailing address

6317 PICCADILLY SQUARE DR
MOBILE AL
36609-5103
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-0322
  • Fax: 251-344-0395
Mailing address:
  • Phone: 251-344-0322
  • Fax: 251-344-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number16402
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: