Healthcare Provider Details

I. General information

NPI: 1114968666
Provider Name (Legal Business Name): RANDALL H JAMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 1ST AVE HIGHAWN MEDICAL BUILDING, STE 504
HUNTINGTON WV
25702-1236
US

IV. Provider business mailing address

2828 1ST AVE HIGHAWN MEDICAL BUILDING, STE 504
HUNTINGTON WV
25702-1236
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-7212
  • Fax: 304-399-7215
Mailing address:
  • Phone: 304-399-7212
  • Fax: 304-399-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036111718
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101017513
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2401
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number6154
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDOS-750
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number02003421A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: