Healthcare Provider Details

I. General information

NPI: 1568425361
Provider Name (Legal Business Name): RANDOLPH EAR, NOSE & THROAT ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N PARK ST
ASHEBORO NC
27203-5440
US

IV. Provider business mailing address

124 N PARK ST
ASHEBORO NC
27203-5440
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-1007
  • Fax: 336-625-0350
Mailing address:
  • Phone: 336-625-1007
  • Fax: 336-625-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES BRANTLEY WEST
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 336-625-1007