Organization
RICHARD C RANDOLPH MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD C RANDOLPH M.D. (PRESIDENT)
(601) 825-2466
Entity
Organization
Contact information
Practice address
348 CROSSGATES BLVD, SUITE 2200, BRANDON, MS 39042-2616
(601) 825-2466
(601) 824-8137
Mailing address
348 CROSSGATES BLVD, SUITE 2200, BRANDON, MS 39042-2616
(601) 825-2466
(601) 824-8137
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10006
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03920519
—
MS
01
—
DG3008
PALMETTO GBA RAILROAD MEDICARE
MS
Enumeration date
09/22/2006
Last updated
08/15/2011
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