Healthcare Provider Details

I. General information

NPI: 1942210166
Provider Name (Legal Business Name): THOMAS RANDALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FOURT MISSOULA RD STE 205 MISSOULA FAMILY PEDIATRICS
MISSOULA MT
59804
US

IV. Provider business mailing address

PO BOX 16900
MISSOULA MT
59808
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-0391
  • Fax:
Mailing address:
  • Phone: 406-327-4620
  • Fax: 406-549-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT8543
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMT8543
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: