Individual
RICHARD R RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 LOWELL DR SE, SUITE 10, HUNTSVILLE, AL 35801-3748
(256) 535-5948
(256) 535-5951
Mailing address
420 LOWELL DR SE, SUITE 103, HUNTSVILLE, AL 35801-3754
(256) 535-5940
(256) 535-5954
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20661
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000096070
—
AL
01
—
0005671483
AETNA
—
01
—
020046829
RAILROAD MEDICARE
—
01
—
51096070
BLUE CROSS
AL
01
—
631247522
TAX ID
—
Enumeration date
11/11/2005
Last updated
12/14/2009
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