Healthcare Provider Details

I. General information

NPI: 1962761551
Provider Name (Legal Business Name): RANDALL RAY FEATHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3895 GRAHAMWOOD CV
MEMPHIS TN
38122-3839
US

IV. Provider business mailing address

3895 GRAHAMWOOD CV
MEMPHIS TN
38122-3839
US

V. Phone/Fax

Practice location:
  • Phone: 618-731-1215
  • Fax:
Mailing address:
  • Phone: 618-731-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.139323
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036139323
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: