Individual
LOREN J RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
VAMC, 500 FOOTHILL BLVD (126), SALT LAKE CITY, UT 84148-0001
(801) 584-1242
Mailing address
PO BOX 354, MAGNA, UT 84044-0354
(801) 250-3541
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
111723-4101
UT
Other
Enumeration date
06/23/2006
Last updated
07/08/2007
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