MEDICARE: DR. RANDAL N VINTHER 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	207R00000X	Internal Medicine Physician	H7246	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H7246	OTHER	TX	TEXAS MEDICAL LICENSE
2	00D54F	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1780688648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDAL N VINTHER M.D.

Provider Business Mailing Address
First Line	:	409 RUSSEL BLVD
Second Line	:	SUITE D
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1248
Country	:	US
Telephone Number	:	936-569-8205
Fax Number	:	936-560-6962

Provider Business Practice Location Address
First Line	:	409 RUSSEL BLVD
Second Line	:	SUITE D
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1248
Country	:	US
Telephone Number	:	936-569-8205
Fax Number	:	936-560-6962

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/28/2026

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