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General NPI Number Information
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NPI Number | 1861451502
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Entity Type | Individual
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Provider Name | RANDAL BRUCE MACURAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 3430 W. WHEATLAND ROAD CHARLTON I POB, SUITE 109
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City | DALLAS
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State | TX
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Zip | 75237
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Country | US
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Telephone | 972-296-1983
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Fax | 972-296-2290
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Provider Business Mailing Address
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Address Line | 8267 ELMBROOK DR STE 200
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City | DALLAS
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State | TX
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Zip | 75247-4078
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Country | US
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Telephone | 214-424-2200
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Fax | 214-231-2159
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | E6132
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License Number State | TX
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