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NPI Code Detail

MEDICARE: ALBERT M RANDOLPH MD

MEDICARE: ALBERT M RANDOLPH 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
1207Q00000XFamily Medicine PhysicianMD00030135WA

Other Identifiers

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

General Provider Information

NPI Number : 1548245400
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALBERT M RANDOLPH MD
Provider Business Mailing Address
First Line : PO BOX 1398
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-0309
Country : US
Telephone Number : 509-527-8151
Fax Number : 509-527-8010
Provider Business Practice Location Address
First Line : 1111 S 2ND AVE
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4118
Country : US
Telephone Number : 509-527-8151
Fax Number : 509-527-8010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 06/24/2021

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Directions to “ ALBERT M RANDOLPH MD” Practice Location

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