Individual
CHARLES D RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
411 FORTUYN RD, GRAND COULEE, WA 99133-8718
(509) 633-1911
(509) 633-3644
Mailing address
411 FORTUYN RD, GRAND COULEE, WA 99133-8718
(509) 633-1911
(509) 633-3644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61172546
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2136043
—
WA
Enumeration date
05/30/2019
Last updated
07/07/2022
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