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General NPI Number Information
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NPI Number | 1851355630
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Entity Type | Individual
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Provider Name | WILLIAM JOHN RANDALL MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 1900 COMPOSITE DRIVE
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City | KETTERING
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State | OH
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Zip | 45420-1475
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Country | US
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Telephone | 937-293-8419
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Fax | 937-293-1545
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Provider Business Mailing Address
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Address Line | 25 MERCHANT STREET SUITE 220
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City | CINCINNATI
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State | OH
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Zip | 45246-3740
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Country | US
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Telephone | 513-533-6507
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Fax | 513-645-9767
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.059106 R
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License Number State | OH
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