Individual
DERRICK RANDDOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 W 5TH ST, ODESSA, TX 79763-4206
(432) 703-5375
(432) 703-5238
Mailing address
24165 W INTERSTATE 10 STE 202, SAN ANTONIO, TX 78257-1160
(726) 225-2290
(281) 845-7063
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
R4622
TX
207Q00000X
Family Medicine Physician
Primary
R4622
TX
Other
Enumeration date
05/20/2015
Last updated
02/26/2025
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