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General NPI Number Information
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NPI Number | 1629103619
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Entity Type | Individual
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Provider Name | MARK ALFORD RANDEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 3618 N UNIVERSITY DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2539
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Country | US
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Telephone | 936-568-9993
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Fax | 936-568-9996
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Provider Business Mailing Address
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Address Line | PO BOX 630668
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City | NACOGDOCHES
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State | TX
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Zip | 75963-0668
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Country | US
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Telephone | 936-568-9993
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Fax | 936-568-9996
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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 | 16951
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | H6529
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 16951
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | H6529
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License Number State | TX
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