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General NPI Number Information
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NPI Number | 1003847716
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Entity Type | Individual
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Provider Name | RANDY CRAIG RANDALL MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 1783 TROUP HIGHWAY
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City | TYLER
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State | TX
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Zip | 75701
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Country | US
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Telephone | 903-595-2283
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Fax | 903-595-1063
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Provider Business Mailing Address
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Address Line | PO BOX 702620
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City | TULSA
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State | OK
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Zip | 74170-2620
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Country | US
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Telephone | 888-608-7999
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Fax | 512-331-1605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | F9993
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License Number State | TX
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