MEDICARE: DR. RANDALL DAVID BLINN 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	207X00000X	Orthopaedic Surgery Physician	ME0063265	FL

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	:	1407852346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL DAVID BLINN M.D.

Provider Business Mailing Address
First Line	:	11440 SW 88TH ST
Second Line	:	STE 111
City	:	MIAMI
State	:	FL
Zip	:	33176-1024
Country	:	US
Telephone Number	:	305-279-2840
Fax Number	:	305-279-2644

Provider Business Practice Location Address
First Line	:	11440 SW 88TH ST
Second Line	:	STE 111
City	:	MIAMI
State	:	FL
Zip	:	33176-1024
Country	:	US
Telephone Number	:	305-279-2840
Fax Number	:	305-279-2644

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/01/2013

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