Healthcare Provider Details

I. General information

NPI: 1073691499
Provider Name (Legal Business Name): RANDALL H PARADIS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S BOYLAN AVE
RALEIGH NC
27603-2246
US

IV. Provider business mailing address

PO BOX 37126
RALEIGH NC
27627-7126
US

V. Phone/Fax

Practice location:
  • Phone: 919-733-0755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number1449
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: