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Individual

KYLE D. RANDOLPH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-5551
Mailing address
933 BRADBURY DR SE STE 2222, ALBUQUERQUE, NM 87106-4375
(505) 272-3120
(505) 272-8060

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A-2474-21
NM
390200000X
Student in an Organized Health Care Education/Training Program
NM

Other

Enumeration date
03/26/2018
Last updated
05/20/2021
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