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NPI Code Detail

MEDICARE: CLEVELAND W RANDOLPH, JR, MD, PA

MEDICARE: CLEVELAND W RANDOLPH, JR, MD, PA
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
1174400000XSpecialistME0042493FL

General Provider Information

NPI Number : 1497808182
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEVELAND W RANDOLPH, JR, MD, PA
Provider Business Mailing Address
First Line : 1891 BEACH BLVD STE 200
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-2644
Country : US
Telephone Number : 904-249-3743
Fax Number : 904-249-2047
Provider Business Practice Location Address
First Line : 1891 BEACH BLVD STE 200
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-2644
Country : US
Telephone Number : 904-249-3743
Fax Number : 904-249-2047
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : VICTORIA LOUISE GALLER
Credential :
Telephone Number : 904-249-3743
Provider Enumeration Date : 01/18/2007
Last Update Date : 12/01/2025

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