Individual
DR. DONALD RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
630 MEDICAL DR, BOUNTIFUL, UT 84010-4908
(801) 299-2186
Mailing address
630 MEDICAL DR, BOUNTIFUL, UT 84010-4908
(801) 299-2186
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2663822501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
—
05
—
876000308007
—
UT
Enumeration date
07/12/2006
Last updated
10/17/2013
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