Healthcare Provider Details

I. General information

NPI: 1053300319
Provider Name (Legal Business Name): RANDALL WILLIAM FRANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE STE 365
MEMPHIS TN
38104-7542
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6018
  • Fax: 901-201-4203
Mailing address:
  • Phone: 901-478-0954
  • Fax: 901-478-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35067907
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number61503
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: