Healthcare Provider Details

I. General information

NPI: 1932570322
Provider Name (Legal Business Name): ALAN RANDLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 PEBBLE BEACH DR
STOCKTON CA
95219-1912
US

IV. Provider business mailing address

4719 QUAIL LAKES DR SUITE G - 124
STOCKTON CA
95207-5267
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-2335
  • Fax: 209-957-2336
Mailing address:
  • Phone: 209-957-2335
  • Fax: 209-957-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG27961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: