Organization
RANDALL EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL HARRIS MD (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-5950
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-KZ05-RA
BLUE SHIELD
MD
05
—
430000900
—
MD
01
—
J876
BLUE SHIELD/FEP
DC
Enumeration date
05/17/2006
Last updated
12/24/2013
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