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General NPI Number Information
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NPI Number | 1386061026
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Entity Type | Individual
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Provider Name | RANDOLPH FERRELL MDIV
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Gender | Male
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 4071 L B MCLEOD RD STE A
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City | ORLANDO
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State | FL
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Zip | 32811-5662
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Country | US
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Telephone | 407-745-4671
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Fax |
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Provider Business Mailing Address
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Address Line | 5914 LONG PEAK DR
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City | ORLANDO
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State | FL
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Zip | 32810-3244
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Country | US
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Telephone | 321-695-2975
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Fax |
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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