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General NPI Number Information
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NPI Number | 1245286780
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Entity Type | Organization
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Legal Business Name | ROYAL RANDOLPH, JR., M.D., M.P.H., LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2200 MAIN ST SUITE 517
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City | WAILUKU
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State | HI
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Zip | 96793-1681
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Country | US
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Telephone | 808-244-9677
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Fax | 808-244-9677
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Provider Business Mailing Address
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Address Line | PO BOX 1441
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City | WAILUKU
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State | HI
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Zip | 96793-6441
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Country | US
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Telephone | 808-244-9677
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Fax | 808-242-4805
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. ROYAL RANDOLPH JR.
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Credential | M.D.
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Telephone | 808-244-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-4946
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License Number State | HI
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