Healthcare Provider Details

I. General information

NPI: 1013201417
Provider Name (Legal Business Name): RANDALL CLYDE THOMAS JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 N HIGH ST
COLUMBUS OH
43214-3520
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-8387
  • Fax: 614-267-2250
Mailing address:
  • Phone: 513-713-1779
  • Fax: 513-854-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003703
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: