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General NPI Number Information
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NPI Number | 1386484947
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Entity Type | Organization
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Legal Business Name | RANDDOLF PHYSICIANS PLLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 22211 IH 10 W STE 1206
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1742
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Country | US
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Telephone | 917-562-5727
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Fax |
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Provider Business Mailing Address
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Address Line | 24165 W INTERSTATE 10 STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1160
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Country | US
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Telephone | 726-225-2290
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Fax | 281-845-7063
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DERRICK E. RANDDOLF
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Credential | MD
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Telephone | 917-562-5727
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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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