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General NPI Number Information
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NPI Number | 1467457424
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Entity Type | Individual
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Provider Name | ROBERT D RANDALL JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 1665 HERLONG CT SUITE A
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City | ROCK HILL
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State | SC
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Zip | 29732-1193
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Country | US
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Telephone | 803-329-8500
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Fax | 803-329-8511
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Provider Business Mailing Address
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Address Line | 1665 HERLONG CT SUITE A
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City | ROCK HILL
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State | SC
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Zip | 29732-1193
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Country | US
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Telephone | 803-329-8500
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Fax | 803-329-8511
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10864
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20949
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License Number State | NC
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