Individual
DR. RANDALL L MIDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0803000079
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088289
COMMUNITY HEALTH
VA
01
—
211030
BLUE CROSS BLUE SHIELD
VA
Enumeration date
09/02/2006
Last updated
05/29/2008
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