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Individual

MR. RANDALL EUGENE FORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 466-1234
Mailing address
6516 N GREENWICH RD, WICHITA, KS 67226-8247
(316) 466-1234

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary

Other

Enumeration date
07/17/2006
Last updated
07/08/2007
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