Healthcare Provider Details

I. General information

NPI: 1073560017
Provider Name (Legal Business Name): RANDALL CRAIG DEEHRING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5293
US

IV. Provider business mailing address

33709 VINEYARD PARK
AVON OH
44011-3245
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-8000
  • Fax:
Mailing address:
  • Phone: 440-937-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35038444D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: