Healthcare Provider Details

I. General information

NPI: 1093073173
Provider Name (Legal Business Name): RANDA N. A OTHMAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W 5TH ST
ODESSA TX
79763
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 432-335-1421
  • Fax: 432-335-1807
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-10673
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: