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Individual
DR. RANDALL W JENNINGS
Active
Individual
DR. RANDALL W JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036105293
IL
207X00000X
Orthopaedic Surgery Physician
Primary
MD166994
OR
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
43003-020
WI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
L09261R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005530345
MEDICARE ID, UNSPECIFIED
WI
01
—
1407812365
GROUP NPI NORTH BEND MEDICAL CENTER
OR
01
—
161133
GROUP MEDICAID NORTH BEND MEDICAL CENTER
OR
05
—
500677744
—
OR
01
—
P01434156
RAILROAD MEDICARE
OR
01
—
R0000WFBTV
GROUP MEDICARE NORTH BEND MEDICAL CENTER
OR
Enumeration date
09/30/2005
Last updated
03/24/2026
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