Individual
TRAVIS RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1 MEDICAL CENTER DR, MORGANTOWN, WV 26506
(304) 598-4800
(304) 293-6963
Mailing address
PO BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01349
WV
Other
Enumeration date
09/03/2008
Last updated
09/03/2008
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