Individual
RANDALL E HALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2101 CORONA RD, STE 102, COLUMBIA, MO 65203-2582
(573) 234-1800
(573) 234-1799
Mailing address
2806 OAK TREE DR, NIXA, MO 65714-9406
(417) 725-8250
(417) 725-8253
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R9D75
MO
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
R9D75
MO
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
R9D75
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080184553
RAILROAD MEDICARE
MO
05
—
1245232693
—
MO
05
—
241991223
—
MO
05
—
241991231
—
MO
01
—
CJ9303
RR MEDICARE - PRIVATE
MO
01
—
P00221221
RR MEDICARE DHOS
—
Enumeration date
08/15/2005
Last updated
10/28/2019
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