Individual
MR. GREGORY W RANDOLPH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 FLEITAS AVE, PASS CHRISTIAN, MS 39571-4507
(228) 452-4888
(228) 452-5006
Mailing address
130 FLEITAS AVE, PASS CHRISTIAN, MS 39571-4507
(228) 452-4888
(228) 452-5006
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
13081
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117253
—
MS
Enumeration date
09/15/2005
Last updated
07/08/2007
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