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General NPI Number Information
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NPI Number | 1225046865
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Entity Type | Organization
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Legal Business Name | GARY M. RANDALL, D.O.,P.A.
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3173
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Country | US
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Telephone | 936-637-2080
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Fax | 936-637-7917
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3173
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Country | US
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Telephone | 936-637-2080
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Fax | 936-637-7917
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GARY MILTON RANDALL
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Credential | D.O.
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Telephone | 936-637-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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