Organization
RANDY WHITESIDE PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL WHITESIDE CP (MANAGER)
(602) 596-4010
Entity
Organization
Contact information
Practice address
1190 E MISSOURI AVE STE 190, PHOENIX, AZ 85014-2736
(602) 596-1040
(480) 212-5944
Mailing address
1190 E MISSOURI AVE STE 190, PHOENIX, AZ 85014-2736
(602) 596-1040
(480) 212-5944
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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