Individual
RANDALL JAY SAMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24668 HAMLET AVE, FOREST LAKE, MN 55025-8781
(612) 290-9056
(651) 464-5671
Mailing address
24668 HAMLET AVE, FOREST LAKE, MN 55025-8781
(612) 290-9056
(651) 464-5671
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
BC743839
MN
Other
Enumeration date
01/30/2020
Last updated
01/30/2020
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