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Organization
RANDOLPH MEDICAL PRACTICES PA
Active
Organization
RANDOLPH MEDICAL PRACTICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY LAVAUGHN RANDOLPH (MD)
(386) 755-1440
Entity
Organization
Contact information
Practice address
1847 SW BARNETT WAY, LAKE CITY, FL 32025-6957
(386) 755-1440
(386) 758-5628
Mailing address
1847 SW BARNETT WAY, LAKE CITY, FL 32025-6957
(386) 755-1440
(386) 758-5628
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME46235
FL
208000000X
Pediatrics Physician
ME51982
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256113100
—
FL
01
—
38690
BCBS GROUP NUMBER
FL
Enumeration date
09/22/2006
Last updated
10/31/2018
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