Healthcare Provider Details

I. General information

NPI: 1033035886
Provider Name (Legal Business Name): RANDALL DOWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 HARDING WAY E
GALION OH
44833-2904
US

IV. Provider business mailing address

1282 HARDING WAY E
GALION OH
44833-2904
US

V. Phone/Fax

Practice location:
  • Phone: 419-606-4629
  • Fax:
Mailing address:
  • Phone: 419-606-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRQ963029
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: