Individual
RANDY CHADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2500 CANYON RD BLDG B, BULLHEAD CITY, AZ 86442-8624
(928) 444-1491
(435) 787-1913
Mailing address
2500 CANYON RD STE 1, BULLHEAD CITY, AZ 86442-8624
(928) 444-1491
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
105209-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000012642
—
UT
Enumeration date
09/07/2006
Last updated
08/28/2020
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