Individual
RANDY WAYNE CALICOTT
Active
Individual
RANDY WAYNE CALICOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
200000741
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
200000741
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050086124
RR MEDICARE
—
01
—
126RJ
BLUE CROSS
NC
01
—
36495
PARTNERS
NC
01
—
5069608
AETNA
NC
05
—
7300263
—
VA
05
—
89126RJ
—
NC
05
—
9801180000
—
WV
01
—
98162
MEDCOST
NC
05
—
Q0074C
—
SC
Enumeration date
01/05/2006
Last updated
08/23/2017
Update your record
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