Individual
RANDELL L PAGE
Active
Individual
RANDELL L PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
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
Update your record
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