Individual
COLLIN DOUGLAS RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4311 11TH AVE NE STE 200, SEATTLE, WA 98105-6367
(206) 616-4001
Mailing address
4311 11TH AVE NE STE 200, SEATTLE, WA 98105-6367
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PT961
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/13/2020
Last updated
11/23/2021
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