MEDICARE: RANDALL H. NATIONS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	37321	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235135369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL H. NATIONS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911416
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-1416
Country	:	US
Telephone Number	:	970-547-9200
Fax Number	:	970-262-2196

Provider Business Practice Location Address
First Line	:	400 N PARK AVE
Second Line	:	# 1-A
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424
Country	:	US
Telephone Number	:	970-547-9200
Fax Number	:	970-262-2196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/07/2014

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