Healthcare Provider Details

I. General information

NPI: 1750372876
Provider Name (Legal Business Name): RANDALL R. WROBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 SMITHS MILL RD
NEW ALBANY OH
43054-8195
US

IV. Provider business mailing address

7277 SMITHS MILL RD
NEW ALBANY OH
43054-8195
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-6331
  • Fax: 614-221-9042
Mailing address:
  • Phone: 614-221-6331
  • Fax: 614-221-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.054967
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35-05-4967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: