Individual
BENJAMIN T RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
(615) 327-4304
Mailing address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN13084
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009913711
—
AL
01
—
01164986
AMERIGROUP
TN
05
—
3600164
—
TN
01
—
4173438
BCBS
TN
01
—
620931432
TRICARE REGION SOUTH
TN
05
—
7100031660
—
KY
Enumeration date
01/11/2008
Last updated
06/12/2008
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