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General NPI Number Information
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NPI Number | 1013131374
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Entity Type | Organization
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Legal Business Name | GERALD G. RANDOLPH, M.D., INC., P.S.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 406 YAUGER WAY SW SUITE B
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City | OLYMPIA
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State | WA
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Zip | 98502-8151
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Country | US
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Telephone | 206-575-2875
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Fax | 206-575-2874
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Provider Business Mailing Address
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Address Line | 406 YAUGER WAY SW SUITE B
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City | OLYMPIA
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State | WA
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Zip | 98502-8151
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Country | US
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Telephone | 877-368-3926
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Fax | 206-575-2874
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD GUY RANDOLPH
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Credential | M.D.
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Telephone | 877-368-3926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD00010827
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License Number State | WA
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