Individual
DR. JOSEPH JUSTIS RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1406 6TH AVE N, ST CLOUD, MN 56303-1901
(320) 255-5657
(320) 656-7194
Mailing address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1900
(320) 255-5657
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
42563
MN
207P00000X
Emergency Medicine Physician
MD60181938
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164497830
—
WA
Enumeration date
02/17/2006
Last updated
02/17/2011
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