Individual
JEFFREY C RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6265 ROCK CHALK DR STE 1500, LAWRENCE, KS 66049-5232
(785) 843-9125
(785) 505-5312
Mailing address
325 MAINE STREET, LAWRENCE, KS 66044
(785) 505-2988
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0425975
KS
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0425975
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100279030A
—
KS
05
—
30004240780001
—
KS
Enumeration date
05/03/2006
Last updated
10/11/2023
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