Individual
RANDELL L PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 463-3234
(208) 463-3044
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 463-3044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
088
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006056
BLUE SHIELD
ID
05
—
002365800
—
ID
01
—
110057530
RAILROAD MEDICARE
ID
01
—
S0883
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
12/18/2013
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