Individual
RANDALL J WENDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8121 MADISON BLVD, STE. 101-A, MADISON, AL 35758-2080
(256) 325-6499
(256) 325-3195
Mailing address
40 BALDWIN AVE, LUGOFF, SC 29078-9406
(803) 408-3262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14718
SC
207Q00000X
Family Medicine Physician
MD.13299
AL
207V00000X
Obstetrics & Gynecology Physician
13299
AL
207V00000X
Obstetrics & Gynecology Physician
24803
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200078790A
—
OK
Enumeration date
06/15/2006
Last updated
12/09/2017
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