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General NPI Number Information
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NPI Number | 1023752433
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Entity Type | Individual
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Provider Name | WILSON RANDALL ORMSBY DO
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Gender | Male
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 590 MEDICAL CENTER RD, BUILDING 36065
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City | FORT CAVAZOS
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State | TX
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Zip | 76544
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Country | US
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Telephone | 801-369-6214
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Fax |
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Provider Business Mailing Address
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Address Line | CRDAMC TROOP MEDICAL CLINIC 12, 7015 E MURPHY RD.
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City | FORT CAVAZOS
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State | TX
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Zip | 76544
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Country | US
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Telephone | 801-369-6214
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DOS-2498
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License Number State | HI
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