MEDICARE: DR. JAMES MICHAEL RANDLE 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	207T00000X	Neurological Surgery Physician	K8445	TX

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
2	88720X	OTHER	TX	BLUE CROSS
3	MDK8445	OTHER	TX	WORKERS COMPENSATION

General Provider Information

NPI Number	:	1457460370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL RANDLE M.D.

Provider Business Mailing Address
First Line	:	5500 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1372
Country	:	US
Telephone Number	:	936-560-6999
Fax Number	:	936-560-0184

Provider Business Practice Location Address
First Line	:	5500 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1372
Country	:	US
Telephone Number	:	936-560-6999
Fax Number	:	936-560-0184

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/10/2010

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