Individual
RANDALL NORMAN WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4402 SHIPYARD BLVD, WILMINGTON, NC 28403-6161
(910) 452-1400
(910) 332-1072
Mailing address
4402 SHIPYARD BLVD, WILMINGTON, NC 28403-6161
(910) 452-1400
(910) 332-1072
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
200400437
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1368Y
BCBS
NC
05
—
891368Y
—
NC
01
—
D7960
MEDCOST
NC
01
—
P00311531
RAILROAD MEDICARE
NC
05
—
Q0043G
—
SC
Enumeration date
06/13/2005
Last updated
11/24/2009
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