Healthcare Provider Details

I. General information

NPI: 1396791455
Provider Name (Legal Business Name): RANDALL BRIAN RIGDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N SYKES CREEK PKWY STE 202
MERRITT ISLAND FL
32953-3494
US

IV. Provider business mailing address

270 N SYKES CREEK PKWY STE 202
MERRITT ISLAND FL
32953-3494
US

V. Phone/Fax

Practice location:
  • Phone: 321-454-2468
  • Fax: 321-454-2410
Mailing address:
  • Phone: 321-454-2468
  • Fax: 321-454-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME75248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: