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NPI Code Detail

MEDICARE: DR. JOHN RANDALL MCINTIRE MD

MEDICARE: DR. JOHN RANDALL MCINTIRE MD
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
12085R0202XDiagnostic Radiology PhysicianE8707TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
270343OTHERTXAMERIGROUP
3102776OTHERTXSUPERIOR CHIPS

General Provider Information

NPI Number : 1285637363
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN RANDALL MCINTIRE MD
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 700 MEDICAL PKWY
Second Line :
City : BRENHAM
State : TX
Zip : 77833-5413
Country : US
Telephone Number : 979-337-5000
Fax Number : 979-830-2244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 01/27/2022

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Directions to “ DR. JOHN RANDALL MCINTIRE MD” Practice Location

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