Individual
DR. JOHN D RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4050 W MEMORIAL RD FL 3, OKLAHOMA CITY, OK 73120-8382
(405) 608-3800
(405) 608-3830
Mailing address
7800 NW 85TH TER, OKLAHOMA CITY, OK 73132-3385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
13800
OK
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
13800
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100824280B
—
OK
01
—
330004147
RAILROAD MEDICARE
OK
Enumeration date
10/04/2005
Last updated
06/06/2022
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