Healthcare Provider Details

I. General information

NPI: 1972685212
Provider Name (Legal Business Name): RANDAL RAYMOND PEOPLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 SIENA HEIGHTS DR STE 131
HENDERSON NV
89052-4168
US

IV. Provider business mailing address

2865 SIENA HEIGHTS DR STE 131
HENDERSON NV
89052-4168
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-6580
  • Fax:
Mailing address:
  • Phone: 702-616-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG75531
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number6355
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: