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General NPI Number Information
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NPI Number | 1982892501
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Entity Type | Organization
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Legal Business Name | RANDALL B RIGDON LLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 270 N SYKES CREEK PKWY SUITE 202
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3492
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Country | US
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Telephone | 321-454-2468
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Fax | 321-454-2469
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Provider Business Mailing Address
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Address Line | 270 N SYKES CREEK PKWY SUITE 202
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3492
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Country | US
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Telephone | 321-454-2468
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Fax | 321-454-2469
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RANDALL B. RIGDON
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Credential |
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Telephone | 321-536-3634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME75248
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License Number State | FL
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