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Individual
TIMOTHY A RANDALL
Active
Individual
TIMOTHY A RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00030595
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057278
—
OR
01
—
080099846
RR MEDICARE
—
01
—
81334
LABOR & IND
WA
05
—
8148116
—
WA
01
—
8933772
CRIME VICTIMS
WA
Enumeration date
07/05/2005
Last updated
07/30/2012
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