# RANDALL L BRADDOM MD LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457820920
- **Authorized official:** RANDALL L BRADDOM MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (908) 601-7036

## Contact information

- **Practice address:** 1451 EL CAMINO REAL, THE VILLAGES, FL 32159-0041
- **Practice address phone:** (352) 751-8000
- **Mailing address:** 1093 GOLDEN GROVE DR, THE VILLAGES, FL 32162-4023
- **Mailing address phone:** (908) 601-7036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2018
- **Last updated:** 11/14/2018