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General NPI Number Information
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NPI Number | 1205845393
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Entity Type | Individual
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Provider Name | BERYL LYNN RANDOLPH M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 14095 S. MAIN ST. HOUSTON, TX 77035
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City | HOUSTON
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State | TX
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Zip | 77035
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Country | US
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Telephone | 713-426-0027
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Fax | 832-209-7186
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Provider Business Mailing Address
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Address Line | 2150 W 18TH ST STE 300
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City | HOUSTON
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State | TX
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Zip | 77008-1289
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Country | US
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Telephone | 713-426-0027
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Fax | 832-209-7186
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | N4026
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License Number State | TX
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