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General NPI Number Information
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NPI Number | 1326066010
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Entity Type | Organization
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Legal Business Name | RANDY D. PROFFITT, M.D., LLC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 6317 PICCADILLY SQUARE DR
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City | MOBILE
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State | AL
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Zip | 36609-5103
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Country | US
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Telephone | 251-344-0322
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Fax | 251-344-0395
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Provider Business Mailing Address
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Address Line | 6317 PICCADILLY SQUARE DR
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City | MOBILE
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State | AL
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Zip | 36609-5103
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Country | US
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Telephone | 251-344-0322
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Fax | 251-344-0395
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDY D PROFFITT
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Credential | M.D.
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Telephone | 251-607-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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