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General NPI Number Information
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NPI Number | 1750468005
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Entity Type | Organization
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Legal Business Name | RANDY HEAD, MD, APMC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1470 GARRETT RD
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City | MONROE
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State | LA
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Zip | 71202-3913
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Country | US
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Telephone | 318-387-3888
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Fax | 318-324-8967
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Provider Business Mailing Address
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Address Line | 1470 GARRETT RD
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City | MONROE
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State | LA
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Zip | 71202-3913
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Country | US
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Telephone | 318-387-3888
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Fax | 318-324-8967
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. RANDY W HEAD I
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Credential | M.D.
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Telephone | 318-387-3888
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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 | 022410
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License Number State | LA
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