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General NPI Number Information
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NPI Number | 1083826408
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Entity Type | Organization
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Legal Business Name | RANDALL P. MAYDEW, M.D.
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Dates
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Enumeration Date | 05/06/2007
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Last Update Date | 05/18/2008
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Provider Practice Location Address
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Address Line | 7777 FOREST LN SUITE B238
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City | DALLAS
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State | TX
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Zip | 75230-2505
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Country | US
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Telephone | 972-566-5813
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 WELBORN ST APT 420
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City | DALLAS
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State | TX
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Zip | 75219-5215
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Country | US
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Telephone | 469-964-0807
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Fax | 214-363-7036
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | RANDALL PAUL MAYDEW
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Credential | M.D.
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Telephone | 469-964-0807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | J0589
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License Number State | TX
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